title: Short- and long-term outcomes in patients undergoing valve surgery with end-stage renal failure receiving chronic hemodialysis.
abstract: OBJECTIVE
  The objective of this study was to evaluate the effect of chronic preoperative hemodialysis for end-stage renal failure in patients undergoing valve surgery.
  
  
  METHODS
  A retrospective review of patients undergoing primary valve with or without coronary artery bypass surgery from 1996 to 2008 at a US academic center was performed. The patients were divided into two groups: group 1 underwent valve surgery without preoperative dialysis (n = 5084) and group 2 underwent valve surgery with preoperative dialysis (n = 224). The outcomes were evaluated using multivariate regression analysis, and long-term survival was assessed with Kaplan-Meier plots.
  
  
  RESULTS
  The patients in group 2 were younger (P < .001), were more likely women (P = .04), and presented with New York Heart Association class III-IV (P < .001). The ejection fraction was similar between the two groups (P = .36). The adjusted perioperative morbidity was similar between the two groups for stroke (P = .79) and myocardial infarction (P = .68). Resource use (postoperative length of stay) was greater in group 2 (P < .001), as was in-hospital mortality (group 1, 263/5084 [5.2%] vs group 2, 41/224 [18.3%]; P < .001). The 1-, 5-, and 10-year survival was less in group 2 (P < .001); the median survival was 12 or more years in group 1 and 1.8 years in group 2. Preoperative end-state renal disease, among others, show a trend as an independent predictor for short-term mortality and was a significant predictor for long-term mortality.
  
  
  CONCLUSIONS
  In this large cohort of patients, preoperative dialysis conferred a high risk of perioperative morbidity and mortality and poor long-term survival after valve surgery. Risk stratification and future research efforts should focus on more precise identification of the benefits of valve surgery in this high-risk patient population.
authors.affiliation: Clinical Research Unit, Division of Cardiothoracic Surgery, Joseph B. Whitehead Department of Surgery, Emory University School of Medicine, Atlanta, GA 30308, 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: Patrick D
authors.initials: PD
authors.lastname: Kilgo
authors.forename: Omar M
authors.initials: OM
authors.lastname: Lattouf
authors.forename: John D
authors.initials: JD
authors.lastname: Puskas
authors.forename: Edward P
authors.initials: EP
authors.lastname: Chen
authors.forename: Robert A
authors.initials: RA
authors.lastname: Guyton
mesh_terms: D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass; D005260:Female; D005845:Georgia / Q000453:epidemiology; D006349:Heart Valve Diseases / Q000150:complications / Q000401:mortality / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D016016:Proportional Hazards Models; D006435:Renal Dialysis; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome