title: Heart valve surgery in hemodialysis-dependent patients: nutrition status impact on surgical outcome.
abstract: Valve surgery in hemodialysis-dependent patients is associated with postoperative complications and a high mortality rate, and such patients frequently suffer cachexia. This study aimed to determine pre- and intraoperative risk factors associated with in-hospital mortality and long-term survival in hemodialysis-dependent patients undergoing heart valve surgery from the viewpoint of nutrition status. Eighty-seven hemodialysis-dependent patients who underwent valve surgery between January 1998 and October 2015 were retrospectively reviewed. Thirty-seven potential perioperative risk factors were evaluated. The in-hospital mortality rate was 12.6 % (11 patients). Univariate analysis identified New York Heart Association Functional Classification III or IV, emaciation (body mass index <17.6 kg/m(2)), total cholesterol <120 mg/dl, serum albumin <3.0 mg/dl, emergent/urgent surgery, and intraoperative blood transfusion >3000 ml as predictors of in-hospital death. Multivariate logistic regression analysis confirmed low serum albumin <3.0 mg/dl (hazard ratio 7.22; p = 0.032) and emergent/urgent operation (hazard ratio 43.57; p = 0.035) as independent predictors of in-hospital death. The 1- and 3-year actuarial survival rates were 64.9 ± 5.4 and 51.8 ± 5.8 %, respectively. Long-term survival estimated by log-rank test was negatively impacted by anemia (hemoglobin <10 mg/dl), low serum albumin, emergent/urgent operation, and infective endocarditis. Multivariate analysis using Cox proportional hazards modeling indicated low serum albumin (hazard ratio 2.12; p = 0.047) and emergent/urgent operation (hazard ratio 8.97; p = 0.0002) as independent predictors of remote death. Hypoalbuminemia and emergent/urgent operation are strong predictors of in-hospital and remote death. Malnutrition before surgery should be considered for operative risk estimation, and adequate preoperative nutrition management may improve surgical outcomes for hemodialysis-dependent patients.
authors.affiliation: Department of Cardiovascular Surgery, Jichi Medical School, Yakushiji 3311-1, Shimotsuke, Tochigi, 329-0498, Japan. kj_kawahito@msn.com.
authors.forename: Koji
authors.initials: K
authors.lastname: Kawahito
authors.affiliation: Department of Cardiovascular Surgery, Jichi Medical School, Yakushiji 3311-1, Shimotsuke, Tochigi, 329-0498, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Aizawa
authors.affiliation: Department of Cardiovascular Surgery, Jichi Medical School, Yakushiji 3311-1, Shimotsuke, Tochigi, 329-0498, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Oki
authors.affiliation: Department of Cardiovascular Surgery, Jichi Medical School, Yakushiji 3311-1, Shimotsuke, Tochigi, 329-0498, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Saito
authors.affiliation: Department of Cardiovascular Surgery, Jichi Medical School, Yakushiji 3311-1, Shimotsuke, Tochigi, 329-0498, Japan.
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Misawa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000401:mortality*; D004697:Endocarditis, Bacterial; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006351:Heart Valves / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D007564:Japan / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009752:Nutritional Status; D011183:Postoperative Complications / Q000401:mortality*; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Heart valve replacement; Kidney; Nutrition; Renal function failure