Khan Nadeem A, Shukrullah Bassam, Eckman Peter M, Hryniewicz Katarzyna M
Section of Advanced Heart Failure and Transplant, Minneapolis Heart Institute, 800 E 28th St, Minneapolis, MN 55407, USA.
School of Medicine, Southern Illinois University, Springfield, IL, USA.
Eur Heart J Case Rep. 2024 Mar 8;8(3):ytae062. doi: 10.1093/ehjcr/ytae062. eCollection 2024 Mar.
Infective endocarditis (IE) is a feared complication after surgical valve replacement accounting for 10% to 30% of all cases of IE. Our case is unique as we present a decompensated heart failure patient with IE who urgently needed mechanical circulatory support (MCS) to stabilize while IE was treated. We used Impella to bridge him to sterile state before heart transplant was done. This case highlights the importance of different strategies for bridge to heart transplant in decompensated heart failure patients with endocarditis.
We describe a case of 62-year-old male who initially presented with severe shortness of breath with minimal exertion, weight gain, and lower extremity oedema diagnosed with acute on chronic systolic heart failure (HF) exacerbation (ACC stage D, NYHA class IV). Initial blood cultures and extensive work-up for IE were negative. He continued to decompensate haemodynamically despite inotropic support and the decision was to proceed with durable left ventricular assist device (LVAD) as bridge to orthotopic heart transplantation (OHT). Immediately prior to LVAD implantation, patient's blood cultures became positive for . Echocardiogram revealed IE on bioprosthetic aortic valve. Patient therefore underwent urgent aortic valve replacement (AVR) and was stabilized with Impella 5.5.
We highlight a case where MCS with Impella was used as a bridge to transplant in a decompensated HF patient who was septic. Patient was listed for OHT but was found to be septic due to IE and had to undergo AVR to achieve infection source control prior to undergoing heart transplant. Impella was used effectively to stabilize ACC stage D/NYHA class IV patient while he recovered from AVR and endocarditis before his blood cultures cleared up and he was listed for OHT. He successfully underwent OHT after 3 weeks.
感染性心内膜炎（IE）是外科瓣膜置换术后令人担忧的并发症，占所有IE病例的10%至30%。我们的病例很独特，因为我们介绍了一名失代偿性心力衰竭合并IE的患者，在治疗IE时迫切需要机械循环支持（MCS）以稳定病情。我们使用Impella装置将他过渡到无菌状态，然后进行心脏移植。该病例突出了在失代偿性心力衰竭合并心内膜炎患者中，采用不同策略过渡到心脏移植的重要性。
我们描述了一名62岁男性患者，最初表现为轻微活动即出现严重气短、体重增加和下肢水肿，诊断为慢性收缩性心力衰竭急性加重（ACC D期，NYHA IV级）。最初的血培养及针对IE的广泛检查均为阴性。尽管给予了强心药物支持，他的血流动力学仍持续恶化，于是决定植入耐用的左心室辅助装置（LVAD）作为原位心脏移植（OHT）的过渡。就在LVAD植入前，患者的血培养结果呈阳性。超声心动图显示生物人工主动脉瓣存在IE。因此，患者接受了紧急主动脉瓣置换术（AVR），并使用Impella 5.5装置使其病情稳定。
我们重点介绍了一例使用Impella进行MCS作为失代偿性心力衰竭合并败血症患者移植过渡的病例。该患者被列入OHT名单，但因IE导致败血症，必须先进行AVR以控制感染源，然后才能进行心脏移植。在患者从AVR和心内膜炎恢复过程中，Impella有效地稳定了ACC D期/NYHA IV级患者的病情，直至其血培养结果转阴并被列入OHT名单。3周后，他成功接受了OHT。
