1077. Heart transplantation as salvage treatment for intractable infective endocarditis
Session: Poster Abstract Session: Bacteremia and Endocarditis
Friday, October 5, 2018
Room: S Poster Hall
Posters
  • ID week 1077.pdf (447.3 kB)
  • Background: Infective endocarditis (IE) remains a severe disease with contemporary in-hospital mortality rates of 20%. Although valvular replacement is performed in 50% of patients during the acute phase, heart transplantation remains the last resort in selected patients with extensive perivalvular lesions or end-stage cardiac failure.

    Methods: Cases were identified through the International Collaboration on Endocarditis (ICE) network. All patients who underwent heart transplantation during the acute phase of IE, with at least three months follow-up, were enrolled. Data were extracted from medical charts on a standardized questionnaire. Only patients who fulfilled Duke criteria for definite IE were enrolled.

    Results: Between 1991 and 2017, 19 patients (6 women, 13 men), with a median age of 52 years (interquartile range, 41-61) underwent heart transplantation for IE refractory to optimized medical treatment and/or other cardiac surgery in Spain (n=9), France (n=6), and Colombia, Croatia, Switzerland, and USA (one patient each). IE affected prosthetic (n=10), or native valves (n=9), primarily aortic (56%), and mitral (28%). Pathogens were oral streptococci (n=7), Staphylococcus aureus (n=5, including 2 methicillin-resistant), Enterococcus faecalis (n=2), and Mycoplasma hominis, Haemophilus para-influenzae, Candida albicans (one patient each). Two cases were not documented. Main cardiac lesions were vegetations (n=17), severe regurgitation (n=15), peri-annular abscesses (n=9), prosthetic valve desinsertion (n=4), and intra-cardiac fistula (n=1). Seventeen patients underwent cardiac surgery at least once before transplantation, and 4 patients were on circulatory assistance (left ventricular assist-device, or extra-corporeal membrane oxygenation, 2 patients each). Median delay between first cardiac surgery and transplantation was 28 days (IQR, 18-71). Six patients died (32%), including 4 during the first month post-transplant. Thirteen patients survived, with a median follow-up of 44 months post-transplantation (IQR, 13-88).

    Conclusion: Heart transplantation may be considered as salvage treatment in highly selected patients with intractable infective endocarditis.

    Pierre Tattevin, MD, PHD, Infectious Diseases and Intensive Care Unit, Pontchaillou Univ. Hosp.; ESGIB, Rennes, France, Patricia Muñoz, PhD, Hospital General Gregorio Marañon, Madrid, Spain, Asuncion Moreno, PhD, HOSPITAL CLINIC-IDIBAPS, BARCELONA, Spain, Guillaume Hékimian, MD, Pitié Univ. Hosp., Paris, France, François Delahaye, MD, PhD, Cardiology Hospital, Lyon, France, Xavier Duval, MD, PhD, Université Paris Diderot, Sorbonne Paris Cité, Paris, France, María Ángeles Castel, MD, Thorax Clinic Institute, Hospital Clínic, Barcelona, Spain, Barbara Hasse, MD, Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland, Natalia Jamarillo, MD, University Hospital, Medelin, Colombia, Josip Vincelj, MD, PhD, Institute of Cardiovascular Diseases, Dubrava University Hospital, Zagreb, Croatia, Dannah Wray, MD, Medical University of South Carolina, Charleston, SC, Carlos Mestres, MD, PhD, Department of Cardiovascular Surgery, Herzzentrum University Hospital, Zurich, Switzerland, Jose Miro, MD, PhD, Hospital Clinic - IDIBAPS, Barcelona, Spain and International Collaboration on Endocarditis (ICE)

    Disclosures:

    P. Tattevin, None

    P. Muñoz, None

    A. Moreno, None

    G. Hékimian, None

    F. Delahaye, None

    X. Duval, None

    M. Á. Castel, None

    B. Hasse, None

    N. Jamarillo, None

    J. Vincelj, None

    D. Wray, None

    C. Mestres, None

    J. Miro, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.