Dohmen Pascal M, Binner Christian, Mende Meinhart, Bakhtiary Farhad, Etz Christian, Pfannmüller Bettina, Davierwala Piroze, Borger Michael A, Misfeld Martin, Mohr Friedrich W
Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Leipzig, Germany; Department of Cardiothoracic Surgery, University of the Free State, Bloemfontein, South Africa.
Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Leipzig, Germany.
Ann Thorac Surg. 2015 Feb;99(2):532-8. doi: 10.1016/j.athoracsur.2014.08.025. Epub 2014 Dec 4.
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.
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.
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.
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.
对于正在接受心脏手术的血液透析患者，患有活动性感染性心内膜炎（AIE）的患者发病和死亡风险更高。这项回顾性观察性单中心研究评估了慢性血液透析对主动脉AIE患者主动脉瓣置换术结局的影响。
回顾性收集1994年10月至2011年1月期间根据改良杜克标准诊断为AIE并接受主动脉瓣手术的连续患者的数据。分析术前接受慢性血液透析患者的特征和结局。
992例患者存在主动脉瓣AIE。45例（4.5%）主动脉瓣AIE患者术前接受长期血液透析，其中19例（42.2%）患有糖尿病。平均逻辑欧洲心脏手术风险评估系统（EuroSCORE）为64.2%±32.2%。15例患者中发现24个术前感染性栓子。36例患者微生物培养结果呈阳性，主要致病菌为金黄色葡萄球菌（n = 17）和粪肠球菌（n = 10）。19例患者（42.2%）进行了单纯主动脉瓣置换，26例患者（57.8%）接受了同期手术。平均随访时间为5.3±5.2年（范围0.1至17.1年）。30例患者（66.7%）发生术后并发症。19例患者（42.2%）在术后30天内死亡，其中8例死于心脏原因。
在接受慢性血液透析并因急性AIE接受主动脉瓣置换的患者中，术后死亡率很高，尤其是在接受主动脉根部置换或血培养阴性AIE的患者中。
