Percutaneous mechanical aspiration versus medical management in tricuspid valve infective endocarditis: a systematic review and meta-analysis

INTRODUCTION: Percutaneous mechanical aspiration (PMA) has emerged as a treatment option for patients with tricuspid valve infective endocarditis (TVIE); however, comparative evidence on PMA versus medical management (MM) remains limited. OBJECTIVES: To systematically review and meta-analyze clinical outcomes among patients with TVIE treated with PMA versus MM alone. PATIENTS AND METHODS: PubMed, Embase, Scopus, MEDLINE Ultimate, and Web of Science were searched following the PRISMA guidelines through December 17, 2025. Studies comparing PMA versus MM alone in adult patients with TVIE were included. The primary endpoint was 30-day mortality. Secondary endpoints were in-hospital mortality, 1-year mortality, and hospital length of stay. Risk of bias was assessed using the ROBINS-I V2 (Risk Of Bias In Non-randomized Studies - of Interventions, version 2) tool. Random-effects models were used for quantitative syntheses. RESULTS: Four nonrandomized studies of intervention were included in the systematic review, and 3 studies involving 252 patients were eligible for quantitative synthesis. Pooled analysis showed no significant benefit of PMA over MM alone for 30-day mortality (risk ratio, 0.78; 95% CI, 0.29-2.08; P = 0.62) or 1-year mortality (risk ratio, 0.99; 95% CI, 0.18-5.45; P = 0.99). There was no significant difference in hospital length of stay between the groups (mean difference, 2.40 days; 95% CI, -3.30 to 8.09; P = 0.41). CONCLUSIONS: Current comparative evidence does not demonstrate a mortality benefit of PMA over MM in patients with TVIE; however, the available evidence is limited and of low to very low certainty. Prospective studies are warranted to establish the clinical indications and safety profile of PMA in patients with TVIE.