DISCUSSION:
Infective endocarditis, specifically of prosthetic valves and the aortic
root can pose technical challenges to cardiac reconstruction. The need
for radical debridement in the setting of massive tissue destruction can
leave the surgeon in a situation in which the aortic root, aorto-mitral
curtain and coronaries may all pose challenges. While there are
well-recognized techniques for each of these anatomic issues, having to
employ them all in the same patient is high-risk. When this situation
arises, outside of the box thinking to utilize mechanical circulatory
support in unconventional ways may be meritorious.
Our patient presented a unique challenge given his young age, and
rapidly progressive, destructive endocarditis. This case highlights the
utility of caring for these patients at a tertiary center, specifically
one with cardiac transplant and mechanical circulatory support programs.
The collective input of the multi-disciplinary heart failure team and
technologies available for biventricular mechanical support are
powerful.
TAH as a technology is utilized most commonly to provide biventricular
support in patients with severe biventricular
failure1,2. Data demonstrates that over 50% of
patients implanted with TAH survive to transplant, with a mean time to
transplant of 87-97 days1,3. The use of TAH in the
setting of un-reconstructable, infective endocarditis has been described
previously with favorable reported outcomes3.
In conclusion, we describe an unusual case with a technically successful
outcome utilizing the TAH to treat a patient with severe, destructive
and un-reconstructable prosthetic valve endocarditis. This case
highlights the importance of caring for these clinically complex
patients specifically at tertiary centers where cardiac transplantation
advanced mechanical circulatory support options are available should
standard surgical reconstructive techniques following radical
debridement be insufficient or pose prohibitive risks.