Emergency Heart Transplantation for Recurrent Infective Endocarditis With Irreparable Damage

Infective endocarditis (IE) with irreversible structural damage has high mortality despite conventional surgery. Heart transplantation (HTx) remains underused in active IE owing to guideline limitations and historical contraindications. A 61-year-old man with recurrent prosthetic valve IE (aortic/tricuspid vegetations, perivalvular abscesses, and coronary embolism) developed cardiogenic shock. Multidisciplinary evaluation deemed conventional repair futile. Emergency HTx achieved survival, with no infection recurrence at 4-month follow-up under prolonged antibiotics and immunosuppression. Whereas guidelines reserve HTx for healed IE, recent evidence supports its role in active infection with controlled bacteremia. This case highlights feasibility of HTx in anatomically destructive IE, urging guideline updates to prioritize transplantation over high-risk valve-centric approaches. HTx may represent a last-resort option for end-stage IE with irreparable damage, even in active infection. This exceptional case required both multidisciplinary consensus and timely organ availability. Multidisciplinary protocols integrating prolonged antibiotics and tailored immunosuppression are critical for success.