title: Results of isolated valve replacement in hemodialysis patients.
abstract: Frequent bleeding complications and poor long-term results have been reported after valve replacement in hemodialysis patients. We use mainly bileaflet mechanical valves with low-dose warfarin therapy (target international normalized ratio, 1.8-2.0) in such cases. Data of 27 hemodialysis patients undergoing isolated valve replacement from 1993 to 2002 were retrospectively analyzed. Bileaflet mechanical valves were selected in 23 patients and bioprostheses in 4. Those with mechanical valves were treated with mild anticoagulation therapy. There were 3 (11.1%) early deaths due to ischemic colitis, interstitial pneumonia, and ventricular arrhythmia. There were 3 late deaths and 5 bleeding complications during follow-up. The overall survival rate was 85.2% at 3 years and 72.9% at 5 years. The survival rate of patients with mechanical valves was 82.6% at 3 years and 76.7% at 5 years. One patient with a bioprosthesis experienced structural valvular deterioration after 3 years. The results demonstrate an acceptable long-term outcome. A bileaflet mechanical valve managed with mild anticoagulation therapy is a reasonable strategy for hemodialysis patients.
authors.affiliation: Department of Cardiothoracic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan. kwataru@med.nagoya-u.ac.jp
authors.forename: Wataru
authors.initials: W
authors.lastname: Kato
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Tajima
authors.forename: Sachie
authors.initials: S
authors.lastname: Terasawa
authors.forename: Keisuke
authors.initials: K
authors.lastname: Tanaka
authors.forename: Akihiko
authors.initials: A
authors.lastname: Usui
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Ueda
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D001145:Arrhythmias, Cardiac / Q000209:etiology; D001705:Bioprosthesis; D017091:Colitis, Ischemic / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000188:drug therapy / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D017563:Lung Diseases, Interstitial / Q000209:etiology; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011474:Prosthesis Design; D011475:Prosthesis Failure; D006435:Renal Dialysis / Q000009:adverse effects*; D051437:Renal Insufficiency / Q000150:complications / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants