**4.1 Percutaneous valve debulking in tricuspid valve endocarditis**

Although vast data for the use of percutaneous valve debulking (PTVD) is rare, there are some retrospective data available. George et al., look at a review of 33 consecutive patients over 40 months who were declined traditional surgical management for TVE. Procedural success was defined as the removal of >1 cm of particulate and/or the ability to removal additional particulate. Patients were young with a vast majority being positive for IVDU (73%) with staphylococcal species being the most common causative agent. (75%). The average size of the tricuspid vegetation was 2.1 + 0.7 cm. More than 75% of patients had clearance of bacteremia within 48 hours of the procedure. Roughly 43.5% of patients however had worsening of their tricuspid regurgitation [32]. The same group also compared PTVD to valve replacement in a retrospective study which showed that the 1-year mortality was unchanged between the two cohorts, with the PTVD cohort having a shorter hospital length of stay [33].

A recent multicenter retrospective review showed at in 89 patients, 70% of patients had complete clearance of bacteremia within 48 hours of the procedure with only one patient requiring surgery for severe TR and heart failure. Surprisingly, the TR was unchanged in most patients (60%) and improved in 20% and worsened in 20%. The group of patient who had worsening of their TR were those who was on the borderline of mild–moderate and moderate–severe TR [34].
