**3.2 Circuit**

The circuit consists of ½ inch tubing typically used for extracorporeal circulation with the use of quick connectors which allow for greater efficiency and ease of use. The quick connector are rotating adapters that allows for rotation of the cannula independently without twisting or kinking the circuit tubing. In addition, the circuit has a built in Y-Adapter with touhy insert allowing for over-the-wire capability through a working side port (**Figure 3**). This allows the user to use up to a 17 French adjunctive device alongside the cannula if needed.

**Figure 1.** *AngioVac cannula.*

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**3.3 Pump**

**Figure 3.** *AngioVac circuit.*

**3.4 Placement**

*Contemporary and Evolving Treatment of Tricuspid Endocarditis*

The pump used with this system can be any off the shelf centrifugal pump. The centrifugal pump leverages negative pressure with increase in flow rates to extirpate undesirable material into the trap. Typical flow rates are around 3-4 Liters/minute. Once the material is engaged, flows will almost always come down to zero, but the negative pressure of the pump circulating allows the material to be suctioned up into the cannula and subsequently into the circuit and trap. Cavitation can occasionally occur but is well tolerated on the right side especially if the patient does not have a patent foramen ovale. When cavitation occurs, clamping the inflow and outflow and deairing the circuit is made simple due to the quick connectors.

As mentioned earlier, the AngioVac cannula can be used in the vena cava as well as the right atrium. It is not indicated for use in the pulmonary artery, but centers have used it in the right ventricle on occasion to extirpate vegetation or clot underneath the tricuspid valve. As centers have gained more experience with thromboembolism mainly in the right atrium, more centers are now using AngioVac for vegetations particularly on the tricuspid valve [32–34]. Access is obtained usually percutaneously in both femoral veins or through the right internal jugular vein and

a femoral vein for a veno-venous configuration (**Figure 4**).

*DOI: http://dx.doi.org/10.5772/intechopen.95434*

**Figure 2.** *AngioVac cannula with slide over sheath.*

*Contemporary and Evolving Treatment of Tricuspid Endocarditis DOI: http://dx.doi.org/10.5772/intechopen.95434*
