Key result
Chronic hemodialysis linked to ~383% higher in-hospital mortality after surgery for active infective endocarditis.
Why the study?
The characteristics and surgical outcomes of chronic hemodialysis patients undergoing surgery during active-phase infective endocarditis were unclear.
Does chronic hemodialysis worsen surgical outcomes in patients undergoing surgery for active-phase infective endocarditis?
Cohort (n=58)
No
Does chronic hemodialysis worsen surgical outcomes in patients undergoing surgery for active-phase infective endocarditis?
Chronic hemodialysis patients undergoing surgery for active infective endocarditis have significantly higher in-hospital mortality, worse long-term survival, and more postoperative complications compared to non-hemodialysis patients.
Alerts clinicians to heightened perioperative mortality risk in hemodialysis patients with active IE; observational data leaves open causal mechanisms and management implications.
PURPOSE: The aim of this study was to elucidate the characteristics of chronic hemodialysis (HD) patients requiring surgery during the active phase of infective endocarditis (IE). METHODS: From December 2004 to July 2015, 58 patients underwent surgery in our institute for active IE. Seven patients had been on HD for 1-15 years. Their preoperative profiles and surgical outcomes were compared to those of the other 51 patients (non-HD group). RESULTS: The predominant causative microorganisms in the HD group were Staphylococcus spp, particularly methicillin-resistant Staphylococcus aureus (MRSA), whereas Streptococcus spp were predominant in the non-HD group. Prosthetic dysfunction (stuck valve after mechanical and structural valve dysfunction following bioprosthetic valve replacement), complete atrioventricular (AV) block, and annular abscess formation were more frequent in the HD group. In-hospital mortality was higher in the HD group (29% vs. 6%, p = 0.044). Actuarial survival in the HD and non-HD groups was 43% vs. 87% at 5 years and 43% vs. 76% at 10 years (p = 0.007). CONCLUSIONS: Early and long term outcomes in patients with chronic HD were poor. Compared to other patients, chronic HD patients undergoing valve surgery during active IE had higher incidences of MRSA infection, annular abscess formation, postoperative valve dysfunction, and postoperative complete AV block.
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Omoto et al. (2016) conducted a cohort in Active-phase infective endocarditis (n=58). Chronic hemodialysis vs. Non-hemodialysis was evaluated on In-hospital mortality (p=0.044). Chronic hemodialysis patients undergoing surgery for active infective endocarditis had significantly higher in-hospital mortality (29% vs. 6%, p=0.044) compared to non-hemodialysis patients.
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