Bacterial infections are a contraindication to organ transplantation, but infective endocarditis may require heart transplantation when otherwise untreatable. We describe a heart transplant patient with cardiomyopathy and ongoing defibrillator endocarditis due to Staphylococcus epidermidis. An initial attempt at percutaneous extraction of the 5 implanted leads was unable to eradicate the infection and was complicated by severe decompensation, requiring a new implant for biventricular pacing. Despite continuing bactericidal treatment, the patient showed persistent infection on the implanted leads with further hemodynamic deterioration. The decision was therefore made to list the patient for heart transplantation. The procedure was successful in removing all of the hardware. No recurrence of infection was observed despite persistence of large vegetations on the removed defibrillator leads. The patient had an uneventful postoperative course, remaining free of symptoms with negative blood cultures at 3 months' follow-up. Our experience showed that active infection of defibrillator leads may not represent an absolute contraindication to heart transplantation when all other medical and surgical treatments have been proven to be ineffective.
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