title: Outcome of aortic valve replacement for active infective endocarditis in patients on chronic hemodialysis.
abstract: BACKGROUND
  The high risk of morbidity and mortality for patients on hemodialysis who are undergoing cardiac surgery is increased for those with active infective endocarditis (AIE). This retrospective observational single-center study evaluated the impact of chronic hemodialysis on the outcome of aortic valve replacement in patients with aortic AIE.
  
  
  METHODS
  Data were retrospectively collected for consecutive patients undergoing aortic valve surgery for AIE diagnosed according to modified Duke criteria between October 1994 and January 2011. Characteristics and outcomes of patients receiving preoperative chronic hemodialysis were analyzed.
  
  
  RESULTS
  Aortic valve AIE was present in 992 patients. Forty-five (4.5%) of the aortic valve AIE patients were receiving long-term hemodialysis preoperatively, 19 of whom (42.2%) had diabetes mellitus. Mean logistic EuroSCORE was 64.2% ± 32.2%. Twenty-four preoperative septic emboli were found in 15 patients. Results of microbiologic cultures were positive in 36 patients, with the major causative organisms identified as Staphylococcus aureus (n = 17) and Enterococcus faecalis (n = 10). Isolated aortic valve replacement was performed in 19 patients (42.2%), and 26 patients (57.8%) underwent concomitant procedures. The mean follow-up was 5.3 ± 5.2 years (range, 0.1 to 17.1 years). Postoperative complications occurred in 30 patients (66.7%). Nineteen patients (42.2%) died within 30 days of surgery, which in 8 patients was attributable to a cardiac cause.
  
  
  CONCLUSIONS
  In patients receiving chronic hemodialysis who undergo aortic valve replacement for acute AIE, postoperative mortality is high, especially in patients undergoing aortic root replacement or culture-negative AIE.
authors.affiliation: Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Leipzig, Germany; Department of Cardiothoracic Surgery, University of the Free State, Bloemfontein, South Africa. Electronic address: pascal.dohmen@yahoo.de.
authors.forename: Pascal M
authors.initials: PM
authors.lastname: Dohmen
authors.affiliation: Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Leipzig, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Binner
authors.affiliation: Coordinating Centre for Clinical Studies Leipzig (KKSL), University of Leipzig, Leipzig, Germany.
authors.forename: Meinhart
authors.initials: M
authors.lastname: Mende
authors.affiliation: Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Leipzig, Germany.
authors.forename: Farhad
authors.initials: F
authors.lastname: Bakhtiary
authors.affiliation: Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Leipzig, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Etz
authors.affiliation: Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Leipzig, Germany.
authors.forename: Bettina
authors.initials: B
authors.lastname: Pfannmüller
authors.affiliation: Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Leipzig, Germany.
authors.forename: Piroze
authors.initials: P
authors.lastname: Davierwala
authors.affiliation: Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Leipzig, Germany.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Borger
authors.affiliation: Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Leipzig, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Misfeld
authors.affiliation: Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Leipzig, Germany.
authors.forename: Friedrich W
authors.initials: FW
authors.lastname: Mohr
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000382:microbiology / Q000601:surgery; D000082882:Bicuspid Aortic Valve Disease; D004697:Endocarditis, Bacterial / Q000401:mortality / Q000601:surgery*; D005260:Female; D006330:Heart Defects, Congenital / Q000382:microbiology* / Q000401:mortality / Q000601:surgery*; D006349:Heart Valve Diseases / Q000382:microbiology* / Q000401:mortality / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome