Outcome of Aortic Valve Replacement for Active Infective Endocarditis in Patients on Chronic Hemodialysis

Dohmen, Pascal M.; Binner, Christian; Mende, Maika; Bakhtiary, Farhad; Etz, Christian D.; Pfannmüller, Bettina; Davierwala, Piroze; Borger, Michael A.; Misfeld, Martín; Mohr, Friedrich W.

doi:10.1016/j.athoracsur.2014.08.025

Cited by 18 publications

(14 citation statements)

References 30 publications

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“…S aureus was the most frequent pathogen for IE, irrespective of dialysis status in our study, and this predominance of staphylococcal infection among IE patients has been reported previously for dialysis patients and for the general population . The high prevalence of staphylococcal (both aureus and coagulase negative) IE among dialysis patients, as shown in our study, indicates that the intravascular access site is the most frequent portal of bacteremia in such patients …”

Section: Discussionsupporting

confidence: 89%

Trends and outcomes of infective endocarditis in patients on dialysis

Bhatia

Agrawal

Garg

et al. 2017

Clinical Cardiology

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Dialysis patients are at high risk for infective endocarditis (IE); however, no large contemporary data exist on this issue. We examined outcomes of 44 816 patients with IE on dialysis and 202 547 patients with IE not on dialysis from the Nationwide Inpatient Sample database from 2006 thorough 2011. Dialysis patients were younger (59 AE 15 years vs 62 AE 18 years) and more likely to be female (47% vs 40%) and African-American (47% vs 40%; all P < 0.001). Hospitalizations for IE in the dialysis group increased from 175 to 222 per 10 000 patients (P trend = 0.04). Staphylococcus aureus was the most common microorganism isolated in both dialysis (61%) and nondialysis (45%) groups. IE due to were less likely (all P < 0.001). Dialysis patients had higher in-hospital mortality (aOR: 2.13, 95% CI: 2.04-2.21), lower likelihood of valve-replacement surgery (aOR: 0.82, 95% CI: 0.76-0.86), and higher incidence of stroke (aOR: 1.08, 95% CI: 1.03-1.12; all P < 0.001). We demonstrate rising incidence of IE-related hospitalizations in dialysis patients, highlight significant differences in baseline comorbidities and microbiology of IE compared with the general population, and validate the association of longterm dialysis with worse in-hospital outcomes. K E Y W O R D SInfective Endocarditis, End-Stage Renal Disease, Outcomes

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Section: Discussionsupporting

confidence: 89%

Trends and outcomes of infective endocarditis in patients on dialysis

Bhatia

Agrawal

Garg

et al. 2017

Clinical Cardiology

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“…Finally, 15 retrospective studies fulfilled our inclusion criteria (Figure ). Two studies were excluded as they only selected patients with infective endocarditis. Another was excluded as it only included four patients in the biological valve cohort.…”

Section: Resultsmentioning

confidence: 99%

Tissue valves are preferable for patients with end-stage renal disease: an aggregate meta-analysis

Altarabsheh

Deo²,

Dunlay

et al. 2016

J Card Surg

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“…The proportion of patients with healthcare-associated infective endocarditis has increased to up to 30% of all active infective endocarditis cases [5,6]. These patients are generally older and present with multiple morbidities, such as chronic kidney disease, which is exacerbated by intravenous antibiotic therapy, and the afflicted patients are often subjected to home nursing care [7,8]. Another change over time is that Staphylococcus aureus has become the primary causative pathogen [9].…”

Section: Introductionmentioning

confidence: 99%

Are Sutureless Aortic Valves Suitable for Severe High-Risk Patients Suffering from Active Infective Aortic Valve Endocarditis?

et al. 2017

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BackgroundSutureless aortic valves were introduced to facilitate minimally invasive aortic valve surgery. Since sutureless aortic valves are a feasible procedure, we evaluated if any benefits could be identified in severe high-risk patients with active infective endocarditis of the aortic valve.Material/MethodsBetween April 2014 and April 2015, a total of 42 patients received a sutureless Perceval® aortic valve (Sorin Biomedica Cardio Srl, Saluggia, Italy) for different indications. Nine of these patients (median age 71 years, range 47–83 years) suffered from active infective endocarditis, including four patients with prosthetic aortic valve endocarditis. Five patients underwent prior cardiac surgery, including transcatheter aortic valve implantation (TAVI). The median EuroSCORE II was 29.5% (range 16.8–87.7%). Post-operatively, data regarding mortality, operative results, and early operative morbidity were collected.ResultsThere were no cases of 30-day mortality. Four patients needed abscess closure with pericardium. Three patients underwent left atrial appendix closure: one left ventricular thrombectomy, one bypass grafting, and one arch replacement. Median aortic cross-clamp and cardiopulmonary bypass time was 35 minutes (range 26–88 minutes) and 52 minutes (range 40–133 minutes), respectively. The median intubation time was 14 hours (range 1–9 hours). In these high-risk patients, no postoperative morbidity was found except for one re-intubation due to extensive delirium and one re-exploration. No pacemaker implantation was needed. Echocardiographic evaluation showed no central or para-valvular regurgitation, and a median discharge mean gradient of 5.5 mm Hg (range 2.5–10.0 mm Hg).ConclusionsSutureless aortic valve replacement in very high-risk patients suffering from active infection endocarditis seems to be an option with limited morbidity and appropriate echocardiographic results, however, further studies are needed.

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Outcome of Aortic Valve Replacement for Active Infective Endocarditis in Patients on Chronic Hemodialysis

Cited by 18 publications

References 30 publications

Trends and outcomes of infective endocarditis in patients on dialysis

Trends and outcomes of infective endocarditis in patients on dialysis

Tissue valves are preferable for patients with end-stage renal disease: an aggregate meta-analysis

Are Sutureless Aortic Valves Suitable for Severe High-Risk Patients Suffering from Active Infective Aortic Valve Endocarditis?

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