title: [Early and mid-term outcomes of aortic valve replacement for aortic stenosis in hemodialysis patients].
abstract: We carried out a retrospective evaluation of the early and mid-term outcomes of aortic valve replacement (AVR) for aortic stenosis in hemodialysis patients. Between 2004 and 2012, a total of 40 dialysis patients underwent AVR with or without an additional procedure. Hemodialysis was performed routinely the day before and during the operation. At surgery, decalcification was performed using a cavitron ultrasonic surgical aspirator(CUSA) and a high performance mechanical valve was then implanted, with the exception of elderly patients or those in whom use of oral anticoagulation is contraindicated. A mechanical valve was used in 33 patients and a bioprosthetic valve in 7 patients. Hemodialysis was resumed on the 2nd postoperative day in the majority of patients. There was no intra-operative death and in-hospital mortality was 5%, due to sepsis and intestinal ischemia in 2 of the 40 patients. The mean follow-up period was 33 months. There was no structural valve deterioration in patients with the bioprosthetic valve. Of the 8 late deaths, the reason for deaths was cardiac in 4 patients. Overall survival in the 40 patients was 92%, 79%, and 54% at 1, 3, and 5 years, respectively. Our study demonstrated good early and mid-term outcomes for aortic valve replacement in hemodialysis patients. CUSA was useful for patients with a calcified valve and annulus. A bioprosthetic valve was acceptable for use in elderly patients.
authors.affiliation: Department of Cardiovascular Surgery, Tachikawa Medical Center, Nagaoka, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Okamoto
authors.forename: Kazuo
authors.initials: K
authors.lastname: Yamamoto
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Sugimoto
authors.forename: Takashi
authors.initials: T
authors.lastname: Wakabayashi
authors.forename: Kaori
authors.initials: K
authors.lastname: Kato
authors.forename: Sinya
authors.initials: S
authors.lastname: Mimura
authors.forename: Shinpei
authors.initials: S
authors.lastname: Yoshii
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D001705:Bioprosthesis; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012189:Retrospective Studies; D016896:Treatment Outcome