Year: 2025
Type: article
Study design: Case Report
Abstract: Background: Right atrial thrombus (RAT), though rare, carries a high risk of pulmonary or systemic embolism and a 25–44% mortality rate. In LVAD candidates, coexisting RAT significantly complicates perioperative management due to their critical condition and high risk of decompensation during surgery. Percutaneous thrombectomy offers a less invasive, lower-risk alternative to open surgery, enabling faster recovery. Case Presentation: We present a case of a 76-year-old male with ischemic cardiomyopathy and heart failure secondary to Adriamycin chemotherapy with an ejection fraction (EF) of 26%, diabetes mellitus, and stage 3 chronic kidney disease, scheduled for left ventricular assist device (LVAD) implantation. Preoperative echocardiography revealed a large, multilobulated, mobile thrombus in the right atrium. Given the high surgical risk and thrombus mobility, percutaneous thrombectomy using the AngioVac system (Angiodynamics, Latham, NY, USA) was performed. The thrombus was successfully removed, and the patient was discharged on apixaban for long-term anticoagulation. Advanced medical therapy and transplant/durable LVAD evaluation were delayed by 35 days to allow for the stabilization of any postoperative effects. Conclusions: This case underscores the efficacy of percutaneous thrombectomy as a bridge to LVAD in high-risk patients, reducing thromboembolic complications and supporting safe LVAD implantation.
Source: Journal of Clinical Medicine
DOI: 10.3390/jcm14176242
Institution: Mayo Clinic in Florida
Language: English
Topic: Cardiac tumors and thrombi
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,137
OpenAlex ID: W4413990861