title: Long-term survival for patients with preoperative renal failure undergoing bioprosthetic or mechanical valve replacement.
abstract: BACKGROUND
  The objective of this study was to assess short-term and long-term outcomes after valve replacement with biologic or mechanical prostheses in patients with preoperative end-stage renal disease on chronic dialysis.
  
  
  METHODS
  A retrospective review of patients with end-stage renal disease undergoing valve replacement from January 1996 through March 2008 at Emory Healthcare Hospitals was performed. Outcomes were compared using χ(2) tests and 2-sample t tests. Adjusted long-term survival up to 10 years was assessed with Kaplan-Meier plots and compared between biologic and mechanical replacements using the Cox proportional hazards model.
  
  
  RESULTS
  A total of 202 patients underwent 211 valve replacement operations. Patient age was 20 to 83 years (mean age, 54.8 ± 14.0); 115 of 211 (54.5%) were male. Operations included the following: 100 of 211 (47.4%) isolated aortic; 49 of 211 (23.2%) isolated mitral; 4 of 211 (1.9%) isolated tricuspid; and 58 of 211 (27.5%) combined replacements. Thirteen (6.2%) patients underwent reoperative valve replacements. Most patients received bioprosthetic valves (143 of 211, 67.8%), while 68 of 211 (32.2%) received mechanical valves. Concomitant coronary artery bypass was performed in 53 of 211 (25.1%) patients. Thirty-day mortality was in 42 of 211 patients (19.9%) and was not different between bioprosthetic and mechanical replacements. Overall 10-year survival was 18.1% for all patients and was not influenced by valve type implanted.
  
  
  CONCLUSIONS
  For patients with end-stage renal disease treated with dialysis, valve replacement carries acceptable operative mortality. Long-term survival is similar among patients receiving bioprosthetic versus mechanical valve replacement. Careful risk assessment and choice of valve prosthesis should be performed prior to surgical intervention in this high-risk patient population.
authors.affiliation: Clinical Research Unit, Division of Cardiothoracic Surgery, Joseph B. Whitehead Department of Surgery, Rollins School of Public Health, Atlanta, Georgia, USA. vthoura@emory.edu
authors.forename: Vinod H
authors.initials: VH
authors.lastname: Thourani
authors.forename: Eric L
authors.initials: EL
authors.lastname: Sarin
authors.forename: W Brent
authors.initials: WB
authors.lastname: Keeling
authors.forename: Patrick D
authors.initials: PD
authors.lastname: Kilgo
authors.forename: Robert A
authors.initials: RA
authors.lastname: Guyton
authors.forename: Ameesh B
authors.initials: AB
authors.lastname: Dara
authors.forename: John D
authors.initials: JD
authors.lastname: Puskas
authors.forename: Edward P
authors.initials: EP
authors.lastname: Chen
authors.forename: William A
authors.initials: WA
authors.lastname: Cooper
authors.forename: J David
authors.initials: JD
authors.lastname: Vega
authors.forename: Cullen D
authors.initials: CD
authors.lastname: Morris
authors.forename: Omar M
authors.initials: OM
authors.lastname: Lattouf
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001705:Bioprosthesis; D015331:Cohort Studies; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D055815:Young Adult