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Heart transplantation as salvage therapy for progressive prosthetic valve endocarditis due to methicillin-resistant Staphylococcus epidermidis (MRSE)

Borde, J. P. ; Sitaru, G. ; Kopp, W. H ; Ruhparwar, Arjang ; Ehlermann, Philipp ; Lasitschka, Felix ; Dalpke, Alexander ; Heininger, Alexandra

In: Journal of Cardiothoracic Surgery, 11 (2016), Nr. 100. pp. 1-5. ISSN 1749-8090

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Download (708kB) | Lizenz: Creative Commons LizenzvertragHeart transplantation as salvage therapy for progressive prosthetic valve endocarditis due to methicillin-resistant Staphylococcus epidermidis (MRSE) by Borde, J. P. ; Sitaru, G. ; Kopp, W. H ; Ruhparwar, Arjang ; Ehlermann, Philipp ; Lasitschka, Felix ; Dalpke, Alexander ; Heininger, Alexandra underlies the terms of Creative Commons Attribution 3.0 Germany

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Abstract

Background: Prosthetic valve endocarditis (PVE) has the highest in-hospital mortality among all cases of infective endocarditis (IE), it is estimated at about 40 %. Orthotopic heart transplantation (OHT) as a measure of last resort, may be considered in selected cases where repeated surgical procedures and conservative efforts have failed to eradicate persistent or recurrent IE. Only few clinical data are available regarding this rare indication for OHT, since active IE has traditionally been considered as a contraindication for OHT. Case presentation: We report on a 55 year old male patient who underwent prosthetic valve replacement with a mechanical valved conduit ten years ago and developed now persistent PVE with severe complications due to methicillin-resistant Staphylococcus epidermidis (MRSE). Repeated surgical procedures and conservative efforts have failed to eradicate the pathogen. Regarding the lack of curative options, salvage OHT was discussed as a measure of last resort. 28 months after the first diagnosis of PVE, the patient was successfully transplanted and is now doing well under close follow-up (6 months post-OHT). Conclusions: PVE remains a challenging condition regarding diagnosis and treatment. The presented case underscores the urgent need for an integrated and multidisciplinary approach to patients with suspected and definitive IE - especially in PVE. OHT might be a feasible measure of last resort in selected patients with IE. Our case report adds published clinical experience to this rarely performed procedure and consolidates previous findings.

Item Type: Article
Journal or Publication Title: Journal of Cardiothoracic Surgery
Volume: 11
Number: 100
Publisher: BioMed Central
Place of Publication: London
Date Deposited: 20 Jul 2016 11:11
Date: 2016
ISSN: 1749-8090
Page Range: pp. 1-5
Faculties / Institutes: Medizinische Fakultät Heidelberg > Medizinische Universitäts-Klinik und Poliklinik
Medizinische Fakultät Heidelberg > Chirurgische Universitätsklinik
Medizinische Fakultät Heidelberg > Universitätsklinik für Anaesthesiologie
Medizinische Fakultät Heidelberg > Department for Infectiology
Medizinische Fakultät Heidelberg > Pathologisches Institut
Subjects: 610 Medical sciences Medicine
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