As Drug-Related Heart Infections Climb, Doctors Weigh Ethics of Operating — Or Not

A spike in the number of patients coming in with infected heart valves has surgeons speaking up — because even if the expensive and involved surgery is successful, many of these patients, who inject opioid drugs, still will die young.

That leaves doctors and hospital systems grappling with the ethics of when — or if — to replace the heart valves of IV drug users who may come in months later with the replacement valve infected.

“It’s not a high-mortality surgery,” said cardiothoracic surgeon Dr. Thomas Pollard. “The reason the mortality is so high in these patients is because they go back to their drug use.”

Increase tied to epidemic

Endocarditis, in which a bacterial infection introduced through the bloodstream attaches to heart tissue and destroys it, has been linked to IV drug use for decades.

But until five years ago, drug-related cases were the minority. More commonly, patients would get bacteria in their bloodstream via a serious cut or an infection like pneumonia, or sometimes after a dental problem or medical procedure.

““If I told any hospital administrator, ‘I have this great operation or treatment that’s going to have a 7 percent success rate,' they’d laugh me out of their office.””

Dr. Thomas Pollard, Parkwest Medical Center

Those patients who got endocarditis other than through drug use — especially young ones — almost always not only survived the surgery but had “a good outcome and probably a normal life expectancy,” said Pollard, who’s practiced in several Knoxville-area hospitals and is now at Parkwest Medical Center.

But as the opioid epidemic tightens its grip on East Tennessee, Pollard has seen the number of IV drug users needing the heart valve replacement surgery skyrocket, costing hospitals hundreds of thousands of dollars in uncompensated costs.

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