Surgical treatment of infective endocarditis in patients undergoing chronic hemodialysis.
| Autor: | Yamane K; Division of Cardiothoracic Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA. kyamane777@yahoo.co.jp, Hirose H, Bogar LJ, Cavarocchi NC, Diehl JT |
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| Jazyk: | angličtina |
| Zdroj: | The Journal of heart valve disease [J Heart Valve Dis] 2012 Nov; Vol. 21 (6), pp. 774-82. |
| Abstrakt: | 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. |
| Databáze: | MEDLINE |
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