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.