engleski

Heart Transplantation as Salvage Treatment for Intractable Infective Endocarditis

Infective endocarditis (IE) remains a severe disease with contemporary in-hospital mortalitet rates of 20%. Although valvular replacement is performed in 50% of patients during acute phase, heart transplantation remains the last resort in selected patients with extensive perivalvular lesions or end- stage cardiac failure. Cases were identified through the International Collaboration on Endocarditis (ICE) network. Between 1991 and 2017, 19 patients (6 women, 13 man), with a median age of 52 years underwent heart transplantation for IE refractory to optimized medical treatment and/or other cardiac surgery in Spain (n=9), France (n=6) and Columbia, Croatia, Switzerland, and the United States (one patients each). IE affected prosthetic (n=10), native valves (n=9), primarily aortic (56%), and mitral (28%). Main cardiac lesions were vegetations (n=17), severe regurgitation (n=15), peri- anunular absceses (n=9), prosthetic valve desinsertion (n=4), and intra-cardiac fistula (n=1). Seventeen patients underwent cardiac surgery at least once before transplantation, and four patients were on cirkulatorne assistance (LVAD, or ECMO, two patients each). Six patients died (32%), including four during the first month post-transplant. Thirteen patients survived, with a median follow- up of 44 months post-transplantation (IQR, 13-88). Heart transplantation may be considered as salvage treatment in highly selected patients with intractable infective endocarditis.

Infective Endocarditis

nije evidentirano