Heart Transplantation as Salvage Therapy of Candida tropicalis Prosthetic Aortic Valve Endocarditis

Fungal infective endocarditis (IE) is rare but potentially fatal. Heart transplantation (HT) may be considered in selected patients when conventional therapy fails, but indications remain unclear.

A 44-year-old man developed acute heart failure due to Streptococcus agalactiae native valve IE with severe aortic regurgitation, requiring emergent aortic valve replacement. Early prosthetic valve IE due to Candida tropicalis occurred, complicated by recurrent periprosthetic pseudoaneurysms. Extracardiac infection was excluded. HT was successfully performed. No episodes of rejection or recurrence of IE occurred after 2 years of follow-up.

Although there is little literature on the subject, some cases of HT as salvage treatment for inoperable IE have been reported. HT should be considered an exceptional strategy for highly selected patients. Multidisciplinary decision-making is crucial.

In selected patients with inoperable IE, HT may be a therapeutic option, but it should be framed as an exceptional, last-resort intervention.