Heart transplantation as salvage treatment of intractable infective endocarditis
Résumé
Background - For infective endocarditis (IE) with extensive perivalvular lesions or end-stage cardiac failure, heart transplantation (HT) may be the last resort. Methods - We retrospectively collected all cases of HT for IE within the International Collaboration on Endocarditis (ICE) network. Results - Between 1991 and 2021, 20 patients (5 women, 15 men), median age 50 years [interquartile range, 29-61], underwent HT for IE in Spain ( = 9), France ( = 6), Switzerland ( = 2), Colombia, Croatia, and USA ( = 1). IE affected prosthetic ( = 10), and native valves ( = 10), primarily aortic ( = 11) and mitral ( = 6). The main pathogens were oral streptococci ( = 8), ( = 5), and ( = 2). The major complications included heart failure ( = 18), peri-annular abscess ( = 10), and prosthetic valve dehiscence ( = 4). Eighteen patients had previous cardiac surgery for this episode of IE, and four were on circulatory support before HT (left ventricular assist-device and extra-corporeal membrane oxygenation, 2 patients each). The median time interval between first symptoms of IE and HT was 44.5 days [22-91.5]. The main post-HT complication was acute rejection ( = 6). Seven patients died (35%), four during the first month post-HT. Thirteen (81%) of the 16 patients discharged from the hospital survived with a median follow-up of 35.5 months [4-96.5] after HT, and no relapse of IE. Conclusions - IE is not an absolute contraindication for HT: Our case series and the literature review support that HT may be considered as a salvage treatment in highly-selected patients with intractable IE.