title: Hemorrhage as a life-threatening complication after valve replacement in end-stage renal disease patients.
abstract: OBJECTIVE
  Hemodialysis patients have an increased risk of hemorrhage compared to other patients. This study reports the frequencies of hemorrhage and its impact on the survival of hemodialysis patients after valve replacement.
  
  
  METHODS
  A total of 77 consecutive dialysis patients who underwent prosthetic valve surgery from 1991 to 2011 were retrospectively reviewed. Their mean age was 65.8 ± 9.2 years. Forty-three patients (56%) were male. Fifty-nine patients (77%) had aortic valve replacement, and 23 patients (30%) had mitral valve replacement. Bioprosthetic valves were used in 17 patients (22%).
  
  
  RESULTS
  There were seven in-hospital mortalities (9.1%). The overall estimated Kaplan-Meier survival after 3, 5 and 7 years was 66.6 ± 5.6, 51.1 ± 6.3 and 34.4 ± 6.8%, respectively. Seventeen (22%) bleeding events were observed (5.9% per patient-years) in the follow-up period. Six of the nine patients with cerebral hemorrhages and two of the six with gastrointestinal hemorrhages died. There were no differences in the frequencies of hemorrhage between the patients treated with bioprostheses and mechanical valves.
  
  
  CONCLUSIONS
  This study found that 22% of dialysis patients had hemorrhagic events after valve replacement, and approximately half of them died. Particularly, cerebral hemorrhage was fatal and two thirds of the patients died. So we should meditate the methods to reduce hemorrhage. Therefore, new methods to reduce the risk of hemorrhage are urgently needed.
authors.affiliation: Department of Cardiovascular Surgery, Kumamoto Chuo Hospital, 1-5-1 Tainoshima, Kumamoto, 862-0965, Japan, tarozamurai@hotmail.com.
authors.forename: Taro
authors.initials: T
authors.lastname: Nakatsu
authors.forename: Nobushige
authors.initials: N
authors.lastname: Tamura
authors.forename: Shigeki
authors.initials: S
authors.lastname: Yanagi
authors.forename: Shoichi
authors.initials: S
authors.lastname: Kyo
authors.forename: Takaaki
authors.initials: T
authors.lastname: Koshiji
authors.forename: Ryuzo
authors.initials: R
authors.lastname: Sakata
mesh_terms: D000368:Aged; D001024:Aortic Valve Stenosis / Q000150:complications / Q000601:surgery; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D017052:Hospital Mortality; D006801:Humans; D007564:Japan; D007676:Kidney Failure, Chronic; D008297:Male; D008875:Middle Aged; D008946:Mitral Valve Stenosis / Q000150:complications / Q000601:surgery; D019106:Postoperative Hemorrhage / Q000209:etiology* / Q000401:mortality; D006435:Renal Dialysis; D012189:Retrospective Studies; D016019:Survival Analysis