Value of surgery for infective endocarditis in dialysis patients

Sajjad Raza, Syed T Hussain, Jeevanantham Rajeswaran, Asif Ansari, Matteo Trezzi, Amr Arafat, James Witten, Kirthi Ravichandren, Haris Riaz, Hoda Javadikasgari, Sunil Panwar, Sevag Demirjian, Nabin K Shrestha, Thomas G Fraser, José L Navia, Bruce W Lytle, Eugene H Blackstone, Gösta B Pettersson

Research output: Contribution to journalArticle

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Abstract

OBJECTIVES: To determine the value of surgery for infective endocarditis (IE) in patients on hemodialysis by comparing the nature and invasiveness of endocarditis in hemodialysis and nonhemodialysis patients and their hospital and long-term outcomes, and identifying risk factors for time-related mortality after surgery.

METHODS: From January 1997 to January 2013, 144 patients on chronic hemodialysis and 1233 nonhemodialysis patients underwent valve surgery for IE at our institution. Propensity matching identified 99 well-matched hemodialysis and nonhemodialysis patient pairs for comparison of outcomes.

RESULTS: Staphylococcus aureus infection was more common in hemodialysis patients than in nonhemodialysis patients (42% vs 21%; P < .0001), but invasive disease was similar in the 2 groups (47%; P = .3). Hospital mortality was 13% and 5-year survival was 20% for hemodialysis patients, 20% below that expected in a general hemodialysis population but 15% above that of hemodialysis patients treated nonsurgically for IE. For matched patients, hospital mortality was 13% for hemodialysis patients versus 5.1% for nonhemodialysis patients (P = .05), and survival at 1 and 5 years was 56% versus 83% and 24% versus 59%, respectively (P < .004). Use of an arteriovenous graft for dialysis access (P = .01) and preoperative placement of a pacemaker (P < .0001) were risk factors for late mortality in hemodialysis patients. For matched patients, freedom from reoperation was similar in the hemodialysis and nonhemodialysis groups (P > .9).

CONCLUSIONS: Intermediate-term survival after surgery for IE in hemodialysis patients is substantially worse than that in nonhemodialysis patients, but only slightly worse than that in the general hemodialysis population and substantially better than that in hemodialysis patients with IE treated nonsurgically, supporting continued surgical intervention for IE.

Original languageEnglish
Pages (from-to)61-70.e6
JournalJournal of Thoracic and Cardiovascular Surgery
Volume154
Issue number1
DOIs
Publication statusPublished - Jul 2017

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Endocarditis
Dialysis
Renal Dialysis
Staphylococcus aureus
Survival
Mortality

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Raza, S., Hussain, S. T., Rajeswaran, J., Ansari, A., Trezzi, M., Arafat, A., ... Pettersson, G. B. (2017). Value of surgery for infective endocarditis in dialysis patients. Journal of Thoracic and Cardiovascular Surgery, 154(1), 61-70.e6. https://doi.org/10.1016/j.jtcvs.2017.02.063

Value of surgery for infective endocarditis in dialysis patients. / Raza, Sajjad; Hussain, Syed T; Rajeswaran, Jeevanantham; Ansari, Asif; Trezzi, Matteo; Arafat, Amr; Witten, James; Ravichandren, Kirthi; Riaz, Haris; Javadikasgari, Hoda; Panwar, Sunil; Demirjian, Sevag; Shrestha, Nabin K; Fraser, Thomas G; Navia, José L; Lytle, Bruce W; Blackstone, Eugene H; Pettersson, Gösta B.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 154, No. 1, 07.2017, p. 61-70.e6.

Research output: Contribution to journalArticle

Raza, S, Hussain, ST, Rajeswaran, J, Ansari, A, Trezzi, M, Arafat, A, Witten, J, Ravichandren, K, Riaz, H, Javadikasgari, H, Panwar, S, Demirjian, S, Shrestha, NK, Fraser, TG, Navia, JL, Lytle, BW, Blackstone, EH & Pettersson, GB 2017, 'Value of surgery for infective endocarditis in dialysis patients', Journal of Thoracic and Cardiovascular Surgery, vol. 154, no. 1, pp. 61-70.e6. https://doi.org/10.1016/j.jtcvs.2017.02.063
Raza, Sajjad ; Hussain, Syed T ; Rajeswaran, Jeevanantham ; Ansari, Asif ; Trezzi, Matteo ; Arafat, Amr ; Witten, James ; Ravichandren, Kirthi ; Riaz, Haris ; Javadikasgari, Hoda ; Panwar, Sunil ; Demirjian, Sevag ; Shrestha, Nabin K ; Fraser, Thomas G ; Navia, José L ; Lytle, Bruce W ; Blackstone, Eugene H ; Pettersson, Gösta B. / Value of surgery for infective endocarditis in dialysis patients. In: Journal of Thoracic and Cardiovascular Surgery. 2017 ; Vol. 154, No. 1. pp. 61-70.e6.
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abstract = "OBJECTIVES: To determine the value of surgery for infective endocarditis (IE) in patients on hemodialysis by comparing the nature and invasiveness of endocarditis in hemodialysis and nonhemodialysis patients and their hospital and long-term outcomes, and identifying risk factors for time-related mortality after surgery.METHODS: From January 1997 to January 2013, 144 patients on chronic hemodialysis and 1233 nonhemodialysis patients underwent valve surgery for IE at our institution. Propensity matching identified 99 well-matched hemodialysis and nonhemodialysis patient pairs for comparison of outcomes.RESULTS: Staphylococcus aureus infection was more common in hemodialysis patients than in nonhemodialysis patients (42{\%} vs 21{\%}; P < .0001), but invasive disease was similar in the 2 groups (47{\%}; P = .3). Hospital mortality was 13{\%} and 5-year survival was 20{\%} for hemodialysis patients, 20{\%} below that expected in a general hemodialysis population but 15{\%} above that of hemodialysis patients treated nonsurgically for IE. For matched patients, hospital mortality was 13{\%} for hemodialysis patients versus 5.1{\%} for nonhemodialysis patients (P = .05), and survival at 1 and 5 years was 56{\%} versus 83{\%} and 24{\%} versus 59{\%}, respectively (P < .004). Use of an arteriovenous graft for dialysis access (P = .01) and preoperative placement of a pacemaker (P < .0001) were risk factors for late mortality in hemodialysis patients. For matched patients, freedom from reoperation was similar in the hemodialysis and nonhemodialysis groups (P > .9).CONCLUSIONS: Intermediate-term survival after surgery for IE in hemodialysis patients is substantially worse than that in nonhemodialysis patients, but only slightly worse than that in the general hemodialysis population and substantially better than that in hemodialysis patients with IE treated nonsurgically, supporting continued surgical intervention for IE.",
author = "Sajjad Raza and Hussain, {Syed T} and Jeevanantham Rajeswaran and Asif Ansari and Matteo Trezzi and Amr Arafat and James Witten and Kirthi Ravichandren and Haris Riaz and Hoda Javadikasgari and Sunil Panwar and Sevag Demirjian and Shrestha, {Nabin K} and Fraser, {Thomas G} and Navia, {Jos{\'e} L} and Lytle, {Bruce W} and Blackstone, {Eugene H} and Pettersson, {G{\"o}sta B}",
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T1 - Value of surgery for infective endocarditis in dialysis patients

AU - Raza, Sajjad

AU - Hussain, Syed T

AU - Rajeswaran, Jeevanantham

AU - Ansari, Asif

AU - Trezzi, Matteo

AU - Arafat, Amr

AU - Witten, James

AU - Ravichandren, Kirthi

AU - Riaz, Haris

AU - Javadikasgari, Hoda

AU - Panwar, Sunil

AU - Demirjian, Sevag

AU - Shrestha, Nabin K

AU - Fraser, Thomas G

AU - Navia, José L

AU - Lytle, Bruce W

AU - Blackstone, Eugene H

AU - Pettersson, Gösta B

N1 - Copyright © 2017. Published by Elsevier Inc.

PY - 2017/7

Y1 - 2017/7

N2 - OBJECTIVES: To determine the value of surgery for infective endocarditis (IE) in patients on hemodialysis by comparing the nature and invasiveness of endocarditis in hemodialysis and nonhemodialysis patients and their hospital and long-term outcomes, and identifying risk factors for time-related mortality after surgery.METHODS: From January 1997 to January 2013, 144 patients on chronic hemodialysis and 1233 nonhemodialysis patients underwent valve surgery for IE at our institution. Propensity matching identified 99 well-matched hemodialysis and nonhemodialysis patient pairs for comparison of outcomes.RESULTS: Staphylococcus aureus infection was more common in hemodialysis patients than in nonhemodialysis patients (42% vs 21%; P < .0001), but invasive disease was similar in the 2 groups (47%; P = .3). Hospital mortality was 13% and 5-year survival was 20% for hemodialysis patients, 20% below that expected in a general hemodialysis population but 15% above that of hemodialysis patients treated nonsurgically for IE. For matched patients, hospital mortality was 13% for hemodialysis patients versus 5.1% for nonhemodialysis patients (P = .05), and survival at 1 and 5 years was 56% versus 83% and 24% versus 59%, respectively (P < .004). Use of an arteriovenous graft for dialysis access (P = .01) and preoperative placement of a pacemaker (P < .0001) were risk factors for late mortality in hemodialysis patients. For matched patients, freedom from reoperation was similar in the hemodialysis and nonhemodialysis groups (P > .9).CONCLUSIONS: Intermediate-term survival after surgery for IE in hemodialysis patients is substantially worse than that in nonhemodialysis patients, but only slightly worse than that in the general hemodialysis population and substantially better than that in hemodialysis patients with IE treated nonsurgically, supporting continued surgical intervention for IE.

AB - OBJECTIVES: To determine the value of surgery for infective endocarditis (IE) in patients on hemodialysis by comparing the nature and invasiveness of endocarditis in hemodialysis and nonhemodialysis patients and their hospital and long-term outcomes, and identifying risk factors for time-related mortality after surgery.METHODS: From January 1997 to January 2013, 144 patients on chronic hemodialysis and 1233 nonhemodialysis patients underwent valve surgery for IE at our institution. Propensity matching identified 99 well-matched hemodialysis and nonhemodialysis patient pairs for comparison of outcomes.RESULTS: Staphylococcus aureus infection was more common in hemodialysis patients than in nonhemodialysis patients (42% vs 21%; P < .0001), but invasive disease was similar in the 2 groups (47%; P = .3). Hospital mortality was 13% and 5-year survival was 20% for hemodialysis patients, 20% below that expected in a general hemodialysis population but 15% above that of hemodialysis patients treated nonsurgically for IE. For matched patients, hospital mortality was 13% for hemodialysis patients versus 5.1% for nonhemodialysis patients (P = .05), and survival at 1 and 5 years was 56% versus 83% and 24% versus 59%, respectively (P < .004). Use of an arteriovenous graft for dialysis access (P = .01) and preoperative placement of a pacemaker (P < .0001) were risk factors for late mortality in hemodialysis patients. For matched patients, freedom from reoperation was similar in the hemodialysis and nonhemodialysis groups (P > .9).CONCLUSIONS: Intermediate-term survival after surgery for IE in hemodialysis patients is substantially worse than that in nonhemodialysis patients, but only slightly worse than that in the general hemodialysis population and substantially better than that in hemodialysis patients with IE treated nonsurgically, supporting continued surgical intervention for IE.

U2 - 10.1016/j.jtcvs.2017.02.063

DO - 10.1016/j.jtcvs.2017.02.063

M3 - Article

C2 - 28633210

VL - 154

SP - 61-70.e6

JO - Journal of Thoracic and Cardiovascular Surgery

JF - Journal of Thoracic and Cardiovascular Surgery

SN - 0022-5223

IS - 1

ER -