The Lead Episode 135: A Discussion of Mechanical Vacuum Aspiration and Debulking of Large Vegetations During Cardiac Implantable Electronic Device Extraction

Welcome to this week's episode of The Lead. Join HRS Digital Education Committee member and podcast host Danesh Kella, MBBS, FHRS as he welcomes his guests Rahul N Doshi, MD, FHRS and Robert D Schaller, DO, FHRS. They are discussing Mechanical Vacuum Aspiration and Debulking of Large Vegetations During Cardiac Implantable Electronic Device Extractions, which was published in the Journal of the American College of Cardiology in October 2025.

This article describes the use of mechanical vacuum aspiration systems to debulk large intracardiac vegetations during cardiac implantable electronic device (CIED) extraction, aiming to reduce embolic risk and procedural complications. The authors highlight procedural techniques, patient selection, and safety considerations when combining aspiration with transvenous lead extraction. This approach represents an important adjunctive strategy for managing complex CIED infections with large vegetations.

Learning Objectives

• Describe the role of mechanical vacuum aspiration in the management of large vegetations during CIED extraction procedures.
• Identify patient selection criteria and procedural considerations for safely combining vegetation debulking with transvenous lead extraction.
• Recognize potential risks, benefits, and complications associated with aspiration-assisted extraction in patients with CIED infection.

Article for Discussion: https://www.jacc.org/doi/10.1016/j.jacc.2025.07.043

Article Authors

Yury Malyshev, Marc A. Miller, Anelechi Anyanwu, George C. Shaw, Mouhannad Sadek, Seth Newman, Sakshum Chadha, Maryam Saleem, Nana Gegechkori, Abhishek Maan, Daniel Musikantow, Mohit Turagam, William Whang, Joshua Lampert, Jacob Koruth, Srinivas Dukkipati, Eric Neibart, and Vivek Y. Reddy

Podcast Contributors

Danesh Kella, MBBS, FHRS
Rahul N Doshi, MD, FHRS
Robert D Schaller, DO, FHRS

Host and Contributor Disclosure(s):

D. Kella

• Honoraria/Speaking/Teaching/Consulting: Zoll Medical Corporation, MBW Spectrum

R. Doshi

• Honoraria/Speaking/Teaching/Consulting: Boston Scientific, Kestra, Inc., Abbott, Impulse Dynamics

R. Schaller

• Honoraria/Speaking/Consulting: Medtronic, Boston Scientific, Philips, Cook Medical
• Research: Abbott Medical

Staff Disclosure(s) (note: HRS staff are NOT in control of educational content. Disclosures are provided solely for full transparency to the learner):

S. Sailor: No relevant financial relationships with ineligible companies to disclose.