The authors [1Dohmen P.M. Binner C. Mende M. et al.Outcome of aortic valve replacement for active infective endocarditis in patients on chronic hemodialysis.Ann Thorac Surg. 2015; 99: 532-538Scopus (13) Google Scholar] address an important topic: the surgical management of infective endocarditis in end stage renal disease (ESRD). With the increasing numbers of patients with ESRD, more cardiac surgeons will likely be operating on such patients, thus making this article an important reference for what to anticipate in short-term complications, high mortality, and poor long-term outcomes.The patient ESRD and valvular heart disease complicated with acute endocarditis is the penultimate complex patient because of the multiplicity of acute and chronic risk factors that affect the immune system, hemodynamics, fluid management, and local structural disturbances caused by the infective process.In this article, the authors reported a high 30-day postoperative complication rate affecting 66.7% of patients, a 42.2% 30-day mortality, a 1-year survival that did not reach 30%, and zero survival at 54 months.These results are not too far removed from what we have reported in a retrospective study conducted at Emory University–affiliated hospitals on all patients with ESRD requiring valve surgery, with operative mortality of 19.9%, median survival of 1.2 years, 2-year survival for isolated aortic valve cases of 40%, and 10-year survival of 18% [2Thourani V.H. Sarin E.L. Keeling W.B. et al.Long-term survival for patients with preoperative renal failure undergoing bioprosthetic or mechanical valve replacement.Ann Thorac Surg. 2011; 91: 1127-1134Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar].Every surgeon who operates on patients with ESRD and acute endocarditis should be familiar with this paper. The surgeon should also inform patients and families of the potentially high risk for associated complications and reduced short- and long-term survival benefit. The authors [1Dohmen P.M. Binner C. Mende M. et al.Outcome of aortic valve replacement for active infective endocarditis in patients on chronic hemodialysis.Ann Thorac Surg. 2015; 99: 532-538Scopus (13) Google Scholar] address an important topic: the surgical management of infective endocarditis in end stage renal disease (ESRD). With the increasing numbers of patients with ESRD, more cardiac surgeons will likely be operating on such patients, thus making this article an important reference for what to anticipate in short-term complications, high mortality, and poor long-term outcomes. The patient ESRD and valvular heart disease complicated with acute endocarditis is the penultimate complex patient because of the multiplicity of acute and chronic risk factors that affect the immune system, hemodynamics, fluid management, and local structural disturbances caused by the infective process. In this article, the authors reported a high 30-day postoperative complication rate affecting 66.7% of patients, a 42.2% 30-day mortality, a 1-year survival that did not reach 30%, and zero survival at 54 months. These results are not too far removed from what we have reported in a retrospective study conducted at Emory University–affiliated hospitals on all patients with ESRD requiring valve surgery, with operative mortality of 19.9%, median survival of 1.2 years, 2-year survival for isolated aortic valve cases of 40%, and 10-year survival of 18% [2Thourani V.H. Sarin E.L. Keeling W.B. et al.Long-term survival for patients with preoperative renal failure undergoing bioprosthetic or mechanical valve replacement.Ann Thorac Surg. 2011; 91: 1127-1134Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar]. Every surgeon who operates on patients with ESRD and acute endocarditis should be familiar with this paper. The surgeon should also inform patients and families of the potentially high risk for associated complications and reduced short- and long-term survival benefit. Outcome of Aortic Valve Replacement for Active Infective Endocarditis in Patients on Chronic HemodialysisThe Annals of Thoracic SurgeryVol. 99Issue 2PreviewThe 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. Full-Text PDF