title: Contemporary perioperative results of heart valve replacement in dialysis patients: analysis of 1,616 patients from the Japan adult cardiovascular surgery database.
abstract: OBJECTIVE
  The study aim was to collect Japanese data and stratify the operative risk of valve replacement in patients with end-stage renal failure who required dialysis.
  
  
  METHODS
  The Japan Adult Cardiovascular Surgery Database from 167 participating sites was used; a total of 1,616 records obtained between January 2004 and December 2011 was analyzed. Aortic valve replacement was performed in 1,390 of these patients (86%), mitral valve replacement in 372 (23%), and tricuspid valve replacement in eight (0.5%).
  
  
  RESULTS
  The operative mortality and morbidity were 13.7% and 32%, respectively. Mechanical valves were frequently used even in patients aged >65 years (49%). Patients with bioprosthetic valves were significantly older and more likely to have comorbidities than those with mechanical valves. The operative mortality (11% versus 17%, p <0.01) and major morbidity (29% versus 37%, p <0.01) were significantly higher in patients with bioprosthetic valves. In multivariate analysis, the type of valve prosthesis was not predictive of death. Significant variables with high odds ratios included chronic lung disease (3.72), peripheral artery disease (2.24), and urgent/emergency status (2.33).
  
  
  CONCLUSIONS
  The contemporary results of valve replacement for dialysis patients obtained in Japan are acceptable. Mechanical valves are frequently used, regardless of patient age. From the standpoint of an operative risk model, careful preoperative assessment is more important than the choice of valve prosthesis in dialysis patients.
authors.affiliation: Japan Cardiovascular Surgery Database Organization, Tokyo, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Takeda
authors.affiliation: Japan Cardiovascular Surgery Database Organization, Tokyo, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Miyata
authors.affiliation: Japan Cardiovascular Surgery Database Organization, Tokyo, Japan.
authors.forename: Noboru
authors.initials: N
authors.lastname: Motomura
authors.affiliation: Japan Cardiovascular Surgery Database Organization, Tokyo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Yamauchi
authors.affiliation: Japan Cardiovascular Surgery Database Organization, Tokyo, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Toda
authors.affiliation: Japan Cardiovascular Surgery Database Organization, Tokyo, Japan.
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Sawa
authors.affiliation: Japan Cardiovascular Surgery Database Organization, Tokyo, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Takamoto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D006801:Humans; D007564:Japan; D007676:Kidney Failure, Chronic / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D018579:Patient Selection; D011474:Prosthesis Design; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome