Successful heart transplantation in patients with total artificial heart infections

Abstract

Background

Data are limited on clinical outcomes in patients awaiting heart transplant (HT) with total artificial heart (TAH) infections (TAHIs).

Methods

We retrospectively reviewed all TAH recipients at our center. TAHI was classified as definite if a microorganism was isolated in cultures from the exit site or deep tissues around the TAH, as probable in patients without surgical or microbiologic evidence of infection but no other explanation for persistent or recurrent bloodstream infection (BSI); or possible in patients with clinical suspicion and radiographic findings suggestive of TAHI, but without surgical intervention or microbiologic evidence.

Results

From 2012-2015, a total of 13 patients received a TAH, with a median age at implantation of 52 years (range: 28-60). TAHI occurred in nine patients (seven definite, one probable, one possible) a median of 41 days after implant (range: 17-475). The majority of TAHIs were caused by Staphylococcus species. Seven of nine patients underwent HT (four had pre-HT mediastinal washout, and five had positive HT operative cultures). Three patients had an active BSI caused by the same pathogen causing TAHI at the time of HT, with one developing a post-HT BSI with the same bacteria. No patient developed post-HT surgical site infection caused by the TAHI pathogen. No deaths among HT recipients were attributed to infection.

Conclusion

TAHI is frequently associated with BSI and mediastinitis and Staphylococcus was the most common pathogen. A multimodal approach of appropriate pre- and post-HT antimicrobial therapy, surgical drainage, and heart transplantation with radical mediastinal debridement was successful in curing infection.

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