Patients with right-sided infective endocarditis experience culture clearance after percutaneous mechanical aspiration (PMA), according to results from the CLEAR-IE trial. Abdallah El Sabbagh, MD, of the Mayo Clinic in Jacksonville, Florida, presented these results during a late-breaking clinical science presentation on Wednesday at the Transcatheter Cardiovascular Therapeutics (TCT) 2024 conference in Washington, DC. Right-sided infective endocarditis (RSIE) cases have risen over the past few years, with RSIE occurring in roughly 10% of endocarditis cases. Treatment is limited for these patients; surgery is risky, and antimicrobials aren’t optimal. PMA may provide infection control for RSIE patients. The purpose of the large, multicenter, longitudinal registry CLEAR-IE study was to examine the safety and efficacy of PMA in patients with RSIE between January 2014 and January 2024. A total of 256 patients (mean age=43 years, 42.6% female) across 19 sites in the US were included in the final analysis. A 6-week in-hospital follow-up was performed. The key endpoints in this study were procedural success, culture clearance (primary efficacy endpoint) and a composite primary safety endpoint of death, new PE and emergency surgery. The primary efficacy outcome, culture clearance, was associated with fewer in-hospital mortality cases (p=0.002), specifically, the bacterial species (odds ratio=9.71, 95% confidence interval=2.27-38.24, p=0.001). No differences was observed with the primary safety outcome. At 6-weeks, death occurred in 7.6% of patients and 8% had recurrence of endocarditis. The investigators noted some limitations of this study: bias from retrospective design, no control group, a heterogenous cohort and no imaging post-procedure to evaluate outcomes. Overall, culture clearance was associated with lower rates of in-hospital mortality in RSIE patients, and PMA led to culture clearance. Image Caption: Abdallah El Sabbagh, MD, speaks during a news conference Wednesday at the Transcatheter Cardiovascular Therapeutics (TCT) conference in Washington, DC. Image Credit: Bailey G. Salimes, CRTonline.org