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Surgical treatment of infective endocarditis in patients undergoing chronic hemodialysis

Kentaro Yamane1, Hitoshi Hirose, Linda J Bogar

  • 1Division of Cardiothoracic Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA. kyamane777@yahoo.co.jp

The Journal of Heart Valve Disease
|February 16, 2013
PubMed

Insights

Surgically treated infective endocarditis (IE) in chronic hemodialysis (HD) patients has poor outcomes. These patients face higher operative mortality and lower survival rates compared to non-HD patients, emphasizing prevention needs.

Area of Science:

  • Cardiology
  • Nephrology
  • Infectious Diseases

Background:

  • Infective endocarditis (IE) is a serious complication for patients on chronic hemodialysis (HD).
  • Surgical management of IE in this population is challenging, with limited data on outcomes.

Purpose of the Study:

  • To characterize surgically managed IE in chronic HD patients.
  • To compare outcomes between HD and non-HD patients undergoing IE surgery.

Main Methods:

  • A retrospective study of 119 patients who underwent surgery for IE between 1998 and 2011.
  • Comparison of perioperative and postoperative outcomes between 16 HD patients and 103 non-HD patients.
  • Survival analysis using the Kaplan-Meier method.

Main Results:

  • HD patients had higher rates of diabetes, Staphylococcus/Enterococcus infections, and annular reconstruction.
  • HD patients experienced increased perioperative intra-aortic balloon pump use, open-chest management, and prolonged ventilation.
  • Operative mortality was significantly higher in HD patients (38% vs. 9.7%), with 1-year survival at 34% vs. 82% (p < 0.001).
  • Chronic HD was an independent predictor of operative and long-term mortality.

Conclusions:

  • Surgical outcomes for IE in chronic HD patients are poor.
  • Preventing IE in chronic HD patients is crucial due to high mortality and morbidity.
Abstract

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