Early and late outcomes of aortic valve replacement in dialysis patients.
BACKGROUND
Few data are available on the outcomes of aortic valve replacement (AVR) in dialysis patients. Valve selection has been controversial, and systemic calcification in these patients has been an important concern. This study reports our experiences and evaluates whether dialysis patients can be treated in a way that is similar to nondialysis patients.


METHODS
A retrospective review was performed on 73 AVRs (43 men, 29 women), including one redo operation, for dialysis patients between 1995 and 2007. Mean age was 65.0 +/- 8.3 years. The bioprosthesis was basically selected for elderly patients as for nondialysis patients.


RESULTS
For a severely calcified ascending aorta, the femoral or subclavian artery was selected for arterial cannulation in 9 patients (12.3%), and aortic cross-clamping under temporary circulatory arrest with moderate hypothermia was applied in 17 (23.3%). Implanted were 51 mechanical and 22 bioprosthetic valves. Four elderly patients in poor general condition received high-performance mechanical valves instead of bioprosthesis to avoid aortic root enlargement. There was no stroke during the perioperative period. Hospital mortality was 6.8%. The overall actuarial survival rate was 74.6% +/- 5.6%, 55.7% +/- 7.6%, and 39.9% +/- 9.7% at 3, 5, and 10 years, respectively.


CONCLUSIONS
The results for the dialysis patients after AVR were satisfactory. Dialysis patients can be treated in AVR just like nondialysis patients. Valve selection and surgical strategy on a case-by-case basis are important to improve the clinical outcomes in dialysis patients.
Tanaka
Keisuke
K
Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan. ktanaka@med.nagoya-u.ac.jp
Tajima
Kazuyoshi
K
Takami
Yoshiyuki
Y
Okada
Noritaka
N
Terazawa
Sachie
S
Usui
Akihiko
A
Ueda
Yuichi
Y
D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000150:complications / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D007564:Japan / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome