title: Valve selection for the aortic position in dialysis patients.
abstract: BACKGROUND
  Prosthetic valve selection in dialysis patients remains controversial because of the limited data available. This study aimed to clarify late clinical outcomes and discuss strategies for optimal valve selection in dialysis patients.
  
  
  METHODS
  We retrospectively analyzed the data obtained from 406 consecutive patients who underwent aortic valve replacement between 1995 and 2010. We compared valve-related outcomes among 89 dialysis and 317 nondialysis patients. We selected bioprostheses for all patients older than 65 to 70 years, irrespective of the renal function.
  
  
  RESULTS
  Dialysis was found to be a significant risk factor for bleeding events (hazard ratio, 3.98; 95% confidence interval, 2.51 to 6.30; p < 0.001), however, no significant differences were observed according to the type of prosthesis. The overall survival was significantly worse in the dialysis patients (63% versus 85% at 5 years; p < 0.001), and freedom from structural valve deterioration was also lower in the dialysis patients (82% versus 100% at 5 years; p < 0.001). Among the dialysis patients, an advanced age (≥ 70 years; hazard ratio, 3.53; p = 0.011), diabetes mellitus (hazard ratio, 2.48; p = 0.041), and concomitant coronary artery bypass grafting (hazard ratio, 1.99; p = 0.071) were independent predictors for late death based on a multivariate analysis.
  
  
  CONCLUSIONS
  Our valve selection criteria in dialysis patients, which are the same as the current practice guidelines for nondialysis patients, are acceptable. Bioprostheses can be considered in all dialysis patients with diabetes or coronary artery disease.
authors: Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan. Electronic address: cvsoka@gmail.com.
authors: Noritaka
authors: N
authors: Okada
authors: Department of Cardiovascular Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan.
authors: Kazuyoshi
authors: K
authors: Tajima
authors: Department of Cardiovascular Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan.
authors: Yoshiyuki
authors: Y
authors: Takami
authors: Department of Cardiovascular Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan.
authors: Wataru
authors: W
authors: Kato
authors: Department of Cardiovascular Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan.
authors: Kei
authors: K
authors: Fujii
authors: Department of Cardiovascular Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan.
authors: Makoto
authors: M
authors: Hibino
authors: Department of Cardiovascular Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan.
authors: Hisaaki
authors: H
authors: Munakata
authors: Department of Cardiovascular Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan.
authors: Yoshimasa
authors: Y
authors: Sakai
authors: Biostatistics Section, Center for Advanced Medicine and Clinical Research, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors: Akihiro
authors: A
authors: Hirakawa
authors: Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors: Akihiko
authors: A
authors: Usui
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000601:surgery; D000082882:Bicuspid Aortic Valve Disease; D001705:Bioprosthesis; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications / Q000401:mortality / Q000601:surgery*; D006349:Heart Valve Diseases / Q000150:complications / Q000401:mortality / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011474:Prosthesis Design; D006435:Renal Dialysis; D012189:Retrospective Studies; D016896:Treatment Outcome