TY - JOUR
T1 - Early and Late Outcomes of Aortic Valve Replacement in Dialysis Patients
AU - Tanaka, Keisuke
AU - Tajima, Kazuyoshi
AU - Takami, Yoshiyuki
AU - Okada, Noritaka
AU - Terazawa, Sachie
AU - Usui, Akihiko
AU - Ueda, Yuichi
N1 - Copyright:
Copyright 2010 Elsevier B.V., All rights reserved.
PY - 2010/1
Y1 - 2010/1
N2 - Background: Few data are available on the outcomes of aortic valve replacement (AVR) in dialysis patients. Valve selection has been controversial, and systemic calcification in these patients has been an important concern. This study reports our experiences and evaluates whether dialysis patients can be treated in a way that is similar to nondialysis patients. Methods: A retrospective review was performed on 73 AVRs (43 men, 29 women), including one redo operation, for dialysis patients between 1995 and 2007. Mean age was 65.0 ± 8.3 years. The bioprosthesis was basically selected for elderly patients as for nondialysis patients. Results: For a severely calcified ascending aorta, the femoral or subclavian artery was selected for arterial cannulation in 9 patients (12.3%), and aortic cross-clamping under temporary circulatory arrest with moderate hypothermia was applied in 17 (23.3%). Implanted were 51 mechanical and 22 bioprosthetic valves. Four elderly patients in poor general condition received high-performance mechanical valves instead of bioprosthesis to avoid aortic root enlargement. There was no stroke during the perioperative period. Hospital mortality was 6.8%. The overall actuarial survival rate was 74.6% ± 5.6%, 55.7% ± 7.6%, and 39.9% ± 9.7% at 3, 5, and 10 years, respectively. Conclusions: The results for the dialysis patients after AVR were satisfactory. Dialysis patients can be treated in AVR just like nondialysis patients. Valve selection and surgical strategy on a case-by-case basis are important to improve the clinical outcomes in dialysis patients.
AB - Background: Few data are available on the outcomes of aortic valve replacement (AVR) in dialysis patients. Valve selection has been controversial, and systemic calcification in these patients has been an important concern. This study reports our experiences and evaluates whether dialysis patients can be treated in a way that is similar to nondialysis patients. Methods: A retrospective review was performed on 73 AVRs (43 men, 29 women), including one redo operation, for dialysis patients between 1995 and 2007. Mean age was 65.0 ± 8.3 years. The bioprosthesis was basically selected for elderly patients as for nondialysis patients. Results: For a severely calcified ascending aorta, the femoral or subclavian artery was selected for arterial cannulation in 9 patients (12.3%), and aortic cross-clamping under temporary circulatory arrest with moderate hypothermia was applied in 17 (23.3%). Implanted were 51 mechanical and 22 bioprosthetic valves. Four elderly patients in poor general condition received high-performance mechanical valves instead of bioprosthesis to avoid aortic root enlargement. There was no stroke during the perioperative period. Hospital mortality was 6.8%. The overall actuarial survival rate was 74.6% ± 5.6%, 55.7% ± 7.6%, and 39.9% ± 9.7% at 3, 5, and 10 years, respectively. Conclusions: The results for the dialysis patients after AVR were satisfactory. Dialysis patients can be treated in AVR just like nondialysis patients. Valve selection and surgical strategy on a case-by-case basis are important to improve the clinical outcomes in dialysis patients.
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U2 - 10.1016/j.athoracsur.2009.10.026
DO - 10.1016/j.athoracsur.2009.10.026
M3 - Article
C2 - 20103207
AN - SCOPUS:76449116525
VL - 89
SP - 65
EP - 70
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
SN - 0003-4975
IS - 1
ER -