Author + information
- Sajjad Raza,
- Asif Ansari,
- Matteo Trezzi,
- Thomas Fraser,
- Jeevanantham Rajeswaran,
- Joseph F. Sabik III,
- Eugene H. Blackstone and
- Gosta B. Pettersson
Valve surgery for infective endocarditis in dialysis patients is high risk. To see if it is worth operating on these patients, we compared their outcomes with those of non–dialysis patients and sought to identify the risk factors related to worse short and long term–survival.
From 1997 to 2007, 831 patients (71% male, mean age 56±15 years) underwent valve surgery for active endocarditis, 89 (11%) of whom were on dialysis preoperatively. A total of 3,170 patient–years of follow–up data were available for analysis. Because dialysis patients had more comorbidities, propensity matching was used and 72 well–matched patient pairs were identified for risk adjusted analysis.
Hospital mortality was 14% for dialysis vs. 7% for non–dialysis patients (P=.2). Dialysis patients had more postoperative pulmonary complications (36% vs. 19%, P=.03), longer intensive care unit (median 5 vs. 3 days, P=.06) and postoperative hospital stays (median 15 vs. 13 days, P=.2). Dialysis patients also had worse long–term survival: 61% vs. 79%, 45% vs. 67%, 32% vs. 59%, and 16% vs. 47% at 1, 3, 5, and 9 years (P[log–rank]=.01), respectively. Reoperation was uncommon and similar (P[log–rank]=.6). In non–dialysis patients, higher blood urea nitrogen and lower glomerular filtration rate were risk factors for early death and both lower and higher glomerular filtration rates were risk factors for late death. In dialysis patients, higher grade of pulmonary valve regurgitation was risk factor for early death whereas larger body mass index was a risk factor for late death. Staphylococcus aureus was the most common cause of infective endocarditis in dialysis patients. However, neither pathogen nor infective endocarditis context, native or prosthetic, was related to short– or long–term survival.
Despite being high risk, one–third of dialysis patients lived beyond 5 years, indicating that surgery is not futile in these patients and should be performed whenever feasible.
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.–10:30 a.m.
Session Title: Optimal Management of Tricuspid Regurgitation and Trends in the Treatment of Endocarditis
Abstract Category: 32. Valvular Heart Disease: Therapy
Presentation Number: 1284–80
- 2013 American College of Cardiology Foundation