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In recent years, there has been a shift in the epidemiology of patients with infective endocarditis (IE). This has been characterized by an alarming increase in IE in patients who inject drugs, cardiac implantable electronic device-related IE, and those with comorbid conditions and high surgical risk. This unmet need has mandated a reevaluation of complex management strategies in these patients and introduction of unconventional approaches in treatment. Percutaneous mechanical aspiration has emerged as both a diagnostic and therapeutic option in selected patients with IE. In this review, the authors discuss the gaps in care of IE, rationale, device armamentarium, procedural, and technical considerations and applications of percutaneous mechanical aspiration in IE., Competing Interests: David Zlotnick is on the speaker’s bureau for Abiomed, Inari Medical. John Moriarty consults for AngioDynamics, Penumbra Medical, Innova Vascular, Pavmed, Pfizer, and Boston Scientific. Nadira Hamid consults for Abbott Structural, Anteris, AMX, 4C Medical Technologies, Alleviant Medical, Edwards Lifesciences, Philips, GE, Valcare Med, VDyne, and WL Gore. Yasir Akhtar received honoraria and is on speaker bureau for AngioDynamics and Penumbra. Kenneth Rosenfield consults for and/or is on the scientific advisory board member for Althea Medical, AngioDynamics, Boston Scientific, Contego, InspireMD, Magneto, Mayo Clinic, Neptune Medical, Philips, Summa Therapeutics, SurModics, Thrombolex, Terumo, and Truvic; holds equity in Accolade, Access Vascular, Aerami, Althea Medical, Contego, Cruzar Systems, Embolitech, Endospan, InspireMD, JanaCare, Magneto, Orchestra BioMed, PQ Bypass, Prosomnus, Shockwave Medical, Summa Therapeutics, Thrombolex, Truvic, and Valcare; and is a board member for National PERT Consortium. Christoph Starck received honoraria, consults for, and is on the advisory board of AngioDynamics, Abiomed, Atricure, Medtronic, Spectranetics, Biotronik, LivaNova (Sorin), and Cook Medical and received departmental or institutional research funding from Cook Medical and Hylomorph. Sripal Bangalore is on the advisory board for Abbott Vascular, Boston Scientific, Biotronik, Amgen, Pfizer, Merck, REATA, Inari Medical, and Truvic. Sahil Parikh receives institutional grants/research support from Abbott Vascular, Shockwave Medical, TriReme Medical, SurModics, Silk Road Medical, and the National Institutes of Health; has received consulting fees from Terumo and Abiomed; and has served on the advisory boards of Abbott, Medtronic, Boston Scientific, CSI, Janssen, and Philips. Sanjum Sethi reports honoraria from Janssen and Chiesi. Abdallah Sabbagh, Evin Yucel, Stephanie Younes, Larry Baddour, and Patrick O’Gara reported no financial interests., (© 2023 The Author(s).)

This study described the first experience with 3-dimensional multiplanar reconstruction transesophageal echocardiography to guide percutaneous alcohol septal ablation. This study demonstrated that 3-dimensional transesophageal echocardiography multiplanar reconstruction allowed for simultaneous assessment of the targeted myocardial area from left ventricular base to apex, akin to imaging seen with spatial imaging with cardiac magnetic resonance. ( Level of Difficulty: Intermediate. )., Competing Interests: Dr Sorajja has served as a consultant for 4C Medical, Abbott Structural, Anteris, Boston Scientific, Edwards LifeSciences, Evolution Medical, Foldax, HighLife, Medtronic, Shifamed, Shockwave, TriFlo, VDyne, and WL Gore. Dr Hamid has served as a consultant for Anteris, Edwards Lifesciences, Philips, Alleviant Medical, AMX Axis, 4C Medical, Valcare Medical, VDyne, and WL Gore. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2023 The Authors.)

Background: Three-dimensional transesophageal echocardiography (3D-TEE) is the primary imaging tool for left atrial appendage closure planning. The utility of cardiac computed tomography angiography (CCTA) and patient-specific computational models is unknown., Objectives: The purpose of this study was to evaluate the accuracy of the FEops HEARTguide patient-specific computational modeling in predicting appropriate device size, location, and compression of the WATCHMAN FLX compared to intraprocedural 3D-TEE., Methods: Patients with both preprocedural and postprocedural CCTA and 3D-TEE imaging of the LAA who received a WATCHMAN FLX left atrial appendage closure device were studied (n = 22). The FEops HEARTguide platform used baseline CCTA imaging to generate a prediction of device size(s), device position(s), and device dimensions. Blinded (without knowledge of implanted device size/position) and unblinded (implant device size/position disclosed) simulations were evaluated., Results: In 16 (72.7%) patients, the blind simulation predicted the final implanted device size. In these patients, the 3D-TEE measurements were not significantly different and had excellent correlation (Pearson correlation coefficient (r) ≥ 0.90). No patients had peridevice leak after device implant. In the 6 patients for whom the model did not predict the implanted device size, a larger device size was ultimately implanted as per operator preference. The model measurements of the unblinded patients demonstrated excellent correlation with 3D-TEE., Conclusions: This is the first study to demonstrate that the FEops HEARTguide model accurately predicts WATCHMAN FLX device implantation characteristics. Future studies are needed to evaluate if computational modeling can improve confidence in sizing, positioning, and compression of the device without compromising technical success., Competing Interests: Dr Vahl has received institutional funding to Columbia University Irving Medical Center from Boston Scientific, Edwards Lifesciences, JenaValve, Medtronic, and Siemens Healthineers; and has personally received consulting fees from Abbott Vascular, Boston Scientific, and Siemens Healthineers. Dr Sommer is a trainer for Boston Scientific’s Watchman device; is an investigator for the following Boston Scientific trials: OPTION and CHAMPION-AF; and is the National Principal Investigator on for two Gore trials: ASSURED and RELIEF. Dr Khalique is part of a corelab contracting with JenaValve, but has not received any direct compensation; has received consulting fees from Abbott Structural and Boston Scientific; and has received Speakers bureau fees from Edwards Lifesciences. Dr Hamid is part of a corelab contracting with JenaValve, but she has not received any direct compensation. Drs Bavo and De Beule are employees of FEops. Dr Hahn has received speaker fees from Abbot Vascular, Baylis Medical, Edwards Lifescience, and Philips Healthcare; institutional consulting contracts with no direct compensation for Abbott Structural, Edwards Lifesciences, Medtronic, Novartis, and Philips Healthcare; and equity with Navigate. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2022 The Authors.)