Long-Term Results Following Aortic Valve Replacement for Aortic Valve Stenosis in Patients with Dialysis-Dependent Renal Failure and Risk Factors for Prognosis

(Department of Cardiovascular Surgery, Kishiwada Tokushukai Hospital, Kishiwada, Japan)

Shuhei Azuma Shin-ichi Higashiue Toshihiro Kawahira
Keiji Matsubayashi Hisashi Tonda Masatoshi Komooka
Norihiko Hiramatsu On-ichi Furuya Masato Nishimura
The objective of this study was to assess the long-term outcomes of aortic valve replacement(AVR)for aortic valve stenosis(AS)in patients undertaking chronic renal hemodialysis at the time of the operation. Seventy five hemodialysis patients who underwent AVR between January 1993 and September 2012 were taken into account in this study. Operations included 40 isolated AVR and 35 concomitant AVR and coronary artery bypass grafting(CABG). Other combined AVR(mitral valve operation and aortic root operation)and emergency operations were excluded. Mean patients’ age was 66.7(±8.5)years and 53 out of 75(70.6%)were male. The etiology of renal failure consisted of diabetic nephropathy(22 cases, 29.3%)and non-diabetic renal failure(53 cases, 70.7%). The mean duration of hemodialysis was 8.1 years. The operative mortality was 6.6%. The 1-year, 3-year, 5 year, and 10-year survival rates were 74.5, 42.1, 29.9, and 6.8%, respectively. Statistical analysis revealed that aortic valve area of less than 0.9cm2 and serum cholinesterase of less than 200IU/l lead to significant risk for mortality(p<0.05). There was no clear difference between the outcomes of isolated AVR and concomitant AVR and CABG. This study suggests that earlier surgical intervention for AS in hemodialysis patients can improve the long-term outcomes, and serum cholinesterase can be a useful preoperative marker to assess operative results.
  Jpn. J. Cardiovasc. Surg. 42:274-278(2013)

Keywords:chronic hemodialysis patients, aortic valve stenosis, aortic valve replacement, remote results, cholinesterase