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Surgical treatment of infective endocarditis in hemodialysis patients
Insights
Surgical valve replacement offers improved survival for hemodialysis patients with infective endocarditis and heart failure, a condition previously fatal with antibiotics alone. Early intervention is key for better outcomes.
Area of Science:
- Cardiology
- Infectious Diseases
- Nephrology
Background:
- Infective endocarditis (IE) in patients on chronic hemodialysis (CHD) with congestive heart failure (CHF) historically carried a uniformly fatal prognosis with antibiotic therapy alone.
- Surgical intervention for IE in this high-risk population has been evaluated to determine its feasibility and impact on survival.
Observation:
- A cohort of 13 patients on CHD underwent infected valve replacement due to IE.
- The aortic valve was the most commonly affected (10 patients), with Staphylococcus aureus being the predominant pathogen (9 patients).
Findings:
- The overall survival rate following valve replacement was 61%.
- Recurrent bacteremia occurred in 2 of 8 long-term survivors, requiring further intervention (antibiotics or prosthesis replacement).
Implications:
- Surgical valve replacement is an acceptable and potentially life-saving therapy for hemodialysis patients with IE and CHF.
- Early surgical intervention, similar to non-dialysis patients, may significantly improve survival rates in this vulnerable patient group.
Abstract:
Congestive heart failure following infective endocarditis in hemodialysis patients has been uniformly fatal in patients treated with antibiotics alone. Thirteen patients on chronic hemodialysis have undergone replacement of the infected valve with an overall survival of 61%. The aortic valve was involved in 10 patients and Staphylococcus aureus the responsible organism in nine. Recurrent bacteremia occurred in two of the eight long-term survivors and was successfully treated with antibiotics in one patient and replacement of the prosthesis in the other. The surgical treatment of infective endocarditis in the hemodialysis patient is an acceptable mode of therapy and its application should not be hindered by reservations concerning operative feasibility or postoperative longevity. As in non-dialysis patients with infective endocarditis and congestive heart failure early operative intervention may substantially improve survival.