Acute heart transplantation from mechanical circulatory support in a human immunodeficiency virus‐positive patient with fulminant myocarditis

Abstract

Since the establishment of highly active antiretroviral therapy, survival rates have improved among patients with human immunodeficiency virus infection giving them the possibility to become transplant candidates. Recent publications revealed that human immunodeficiency virus-positive heart transplant recipients' survival is similar to non-infected patients. We present the case of a 40-year-old human immunodeficiency virus infected patient, who was hospitalized due to severely decreased left ventricular function with a possible aetiology of acute myocarditis, that has later been confirmed by histological investigation of myocardial biopsy. Due to rapid progression to refractory cardiogenic shock, extracorporeal membrane oxygenation implantation had been initiated, which was upgraded to biventricular assist device later. On the 35th day of upgraded support, the patient underwent heart transplantation uneventfully. Our clinical experience confirms that implementation of temporary mechanical circulatory support and subsequent cardiac transplantation might be successful in human immunodeficiency virus-positive patients even in case of new onset, irreversible acute heart failure.

Veno-Arterial Extracorporeal Membrane Oxygenation in Patients with Fulminant Myocarditis: A Review of Contemporary Literature

“…In cases without myocardial recovery, ECMO stabilizes and optimizes cardiogenic shock prior to semi-urgent cardiac transplantation [98]. Multiple case-reports of fulminant myocarditis [99,100] describe successful acute heart transplants in patients who could not be weaned off ECMO. Observational retrospective studies showed that although patients who receive transplant have a relatively high mortality rate, if they do receive a transplant, they have a very high survival rate.…”