David A. D’Alessandro, Edvard Skripochnik, Siyamek Neragi-Miandoab
Department of Cardiovascular and Thoracic Surgery, Albert Einstein College of Medicine, New York, USA
Background and aim of the study: The type of valve prosthesis used in dialysis patients remains the subject of controversy, while calcification of the bioprosthesis has also been of concern.
Methods: In this retrospective study, an analysis was performed of the morbidity and mortality of patients with end-stage renal disease who underwent either mitral valve replacement (MVR) or aortic valve replacement (AVR) between 2006 and 2011.
Results: A total of 95 patients (55 males, 40 females; median age 61 years; range: 32-85 years) was examined. Of these patients, 58 received bioprosthetic valves and 37 mechanical valves. The perioperative mortality was 21% (n = 20); 11 patients (11.6%) died in the biologic valve group (BVG) and nine (9.5%) in the mechanical valve group (MVG) (p = 0.6). Univariate analysis showed that preoperative risk factors such as early extubation <6 h (p = 0.028), peak perioperative lactate level (p = 0.0003),
prolonged perfusion time (p = 0.05), body mass index >30 kg/m2 (p = 0.08), and body surface area >2 m2 (p = 0.04) were predictors of mortality. The multivariate model showed perfusion time to be the only independent risk factor for perioperative mortality (Odds ratio 1.24 for every 30 min beyond 150 min average, CI 1.006-1.543, p = 0.0098). Long-term survival was negatively impacted by concomitant coronary artery bypass grafting, preoperative arrhythmia (p = 0.04), and a postoperative intubation time >6 h (p = 0.012). The one- and five-year survivals for the BVG were 65 ± 6.4% and 34 ± 11%, respectively. The one-year and 40-month survivals for the MVG were 53 ± 8% and 37 ± 10%, respectively (p = 0.49).
Conclusion: The overall survival of dialysis patients was poor, but the type of prosthetic valve had no effect on either perioperative mortality or long-term survival.
The Journal of Heart Valve Disease 2013;22:743-750
|The Significance of Prosthesis Type on Survival Following Valve Replacement in Dialysis Patients|
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