Abstract: Background: For infective endocarditis (IE) with extensive perivalvular lesions or end-stage cardiac failure, heart transplantation (HT) may be the last resort. Methods: We retrospectively collected all cases of HT for IE within the International Collaboration on Endocarditis (ICE) network. Results: Between 1991 and 2021, 20 patients (5 women, 15 men), median age 50 years [interquartile range, 29-61], underwent HT for IE in Spain (n¼9), France (n¼6), Switzerland (n¼2), Colombia, Croatia, and USA (n¼1). IE affected prosthetic (n¼10), and native valves (n¼10), primarily aortic (n¼11) and mitral (n¼6). The main pathogens were oral streptococci (n¼8), Staphylococcus aureus (n¼5), and Enterococcus faecalis (n¼2). The major complications included heart failure (n¼18), peri-annular abscess (n¼10), and prosthetic valve dehiscence (n¼4). Eighteen patients had previous cardiac surgery for this episode of IE, and four were on circulatory support before HT (left ventricular assist-device and extra-corporeal membrane oxygenation, 2 patients each). The median time interval between first symptoms of IE and HT was 44.5 days [22-91.5]. The main post-HT complication was acute rejection (n¼6). Seven patients died (35%), four during the first month post-HT. Thirteen (81%) of the 16 patients discharged from the hospital survived with a median follow-up of 35.5 months [4-96.5] after HT, and no relapse of IE. Conclusions: IE is not an absolute contraindication for HT: Our case series and the literature review support that HT may be considered as a salvage treatment in highly-selected patients with intractable IE

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