Valve replacement surgery in patients with end-stage renal disease: long-term results.
BACKGROUND
The life expectancy of patients with chronic renal failure who are dependent on dialysis is very poor. This study was undertaken to determine time-related outcomes in dialysis patients requiring cardiac valve replacement.


METHODS
From 1994 to 2001, 29 end-stage renal disease (ESRD) patients on hemodialysis (HD) program underwent 30 valve replacement operations: 29 received mechanical valves (97%), and one received bioprosthetic valves. The sites of valve replacement were 11 aortic (36.7%), 18 mitral (60%), and one both aortic and mitral (3.3%). Mean age was 42.46 +/- 14.26 years (range 17-75 years). Follow-up was completed in 28 patients (96.5%).


RESULTS
Early postoperative mortality (in the first 30 days) was 3.4% (n = 1). The overall estimated Kaplan-Meier survival was 56.7% at 36 months, 46.7% at 60 months, and 43.3% at 96 months. HD program was discontinued for two patients after renal transplantation in the follow-up period. All patients, except the one with bioprosthesis, used warfarin sodium for anticoagulation and none of them had bleeding. One of the patients had a major cerebrovascular accident (CVA) and another one had a minor CVA at the follow-up (6.7%).


CONCLUSIONS
Life quality is better and life expectancy is longer after valve replacement in ESRD patients who have valvular disease. Also, longer life expectancy increases the probability for finding donors for kidney transplantation.
Gultekin
Bahadir
B
Department of Cardiovascular Surgery, Baskent University, Ankara, Turkey. bahadirg2002@yahoo.com
Ozkan
Suleyman
S
Uguz
Emrah
E
Atalay
Hakan
H
Akay
Tankut
T
Arslan
Ahmet
A
Sezgin
Atilla
A
Ozdemir
Nurhan
N
Tasdelen
Atilay
A
Aslamaci
Sait
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D001021:Aortic Valve / Q000601:surgery*; D001705:Bioprosthesis; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000150:complications* / Q000401:mortality / Q000601:surgery*; D006350:Heart Valve Prosthesis; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000401:mortality / Q000628:therapy; D016030:Kidney Transplantation; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D006435:Renal Dialysis; D016896:Treatment Outcome; D014859:Warfarin / Q000627:therapeutic use
D000925:Anticoagulants; D014859:Warfarin