Surgical treatment of infective endocarditis in patients undergoing chronic hemodialysis

Background and aim of the study: Infective endocarditis (IE) is a devastating complication in patients undergoing chronic hemodialysis (HD). The study aim was to reveal the characteristics and outcomes of surgically managed IE in chronic HD patients. Methods: Between April 1998 and August 2011, a total of 119 patients underwent surgery to treat IE. Of these patients, 16 were receiving chronic HD preoperatively. A comparison between non-HD patients (n = 103) and HD patients (n = 16) was conducted with regards to perioperative variables and postoperative morbidity and mortality. A survival analysis was performed using the Kaplan-Meier method. Results: Preoperatively, a greater proportion of HD patients had diabetes mellitus than did non-HD patients (44% versus 16% , p = 0.015). Staphylococcus spp. (56%) and Enterococcus spp. (25%) were the predominant microorganisms in HD patients, while Staphylococcus spp. (37%) and Streptococcus spp. (21%) were predominant in non-HD patients. The most affected valve position was the aortic valve, followed by the mitral and the tricuspid in both groups. An annular reconstruction was performed in 56% of HD patients and in 30% of non-HD patients (p = 0.039). The HD patients had a higher incidence of perioperative use of intra-aortic balloon pump placement (25% versus 6.9%, p = 0.042), postoperative open-chest management (38% versus 9.8%, p = 0.009), and prolonged ventilation (63% versus 33%, p = 0.025). The operative mortality was 9.7% in non-HD patients and 38% in HD patients (p = 0.008). Survival at one year was 82% in the non-HD group and 34% in the HD group (p <0.001). Multivariable analysis revealed that chronic HD is an independent predictor of operative and long-term mortality. Conclusion: The operative outcome after endocarditis in HD patients remains poor, and the importance of preventing endocarditis in chronic HD patients is further emphasized.