Intermediate-term outcomes of aortic valve replacement with bioprosthetic or mechanical valves in patients on hemodialysis

The Journal of Thoracic and Cardiovascular Surgery

Taro Nakatsu¹  Kenji Minakata²  Koji Ueyama³  Shiro Tanaka⁴  Kenji Minatoya⁵  Junichiro Nishizawa⁶  Nobuhisa Ohno⁷  Jiro Esaki⁸  Tadaaki Koyama⁹  Michiya Hanyu^1,10  Nobushige Tamura^1,11  Tatsuhiko Komiya^1,12  Naoki Kanemitsu^1,13  Yoshiharu Soga^1,14  Kotaro Shiraga^1,15  Shogo Nakayama^1,16  Michihito Nonaka^1,17  Yuhei Saito^1,18 

[1] Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan;Clinical Biostatistics, Kyoto University Graduate School of Medicine, Kyoto, Japan;Department of Cardiac Surgery, Kokura Memorial Hospital, Kitakyushu, Japan;Department of Cardiovascular Surgery, Hamamatsu Rosai Hospital, Hamamatsu, Japan;Department of Cardiovascular Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan;Department of Cardiovascular Surgery, Japanese Red-Cross Otsu Hospital, Otsu, Japan;Department of Cardiovascular Surgery, Kitano Hospital, Osaka, Japan;Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, Kobe, Japan;Department of Cardiovascular Surgery, Kumamoto Chuo Hospital, Kumamoto, Japan;Department of Cardiovascular Surgery, Kurashiki Central Hospital, Kurashiki, Japan;Department of Cardiovascular Surgery, Matsue Red-Cross Hospital, Matsue, Japan;Department of Cardiovascular Surgery, Mitsubishi Kyoto Hospital, Kyoto, Japan;Department of Cardiovascular Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan;Department of Cardiovascular Surgery, Osaka Red-Cross Hospital, Osaka, Japan;Department of Cardiovascular Surgery, Shiga Medical Center for Adults, Moriyama, Shiga, Japan;Department of Cardiovascular Surgery, Takamatsu Red-Cross Hospital, Takamatsu, Japan;Department of Cardiovascular Surgery, Tenri Hospital, Tenri, Japan;Division of Cardiovascular Surgery, Nagahama City Hospital, Nagahama, Japan

关键词: hemodialysis;    end-stage renal disease;    prosthetic valve;    durability;    aortic valve;   

DOI  :  10.1016/j.jtcvs.2018.08.104

学科分类：心脏病和心血管学

来源: Mosby, Inc.

【 摘 要 】

ObjectiveTo investigate the influence of choice of prosthesis (bioprosthetic valves or mechanical valves) on intermediate-term outcomes in patients on hemodialysis undergoing aortic valve replacement (AVR).MethodsA multi-institutional retrospective cohort study was conducted in 18 Japanese centers. All adult patients on chronic hemodialysis who underwent AVR from 2008 and 2015 were included (n = 491). The early and late results were compared between groups. The hazard ratios were calculated using Cox regression and Fine–Gray models with adjustment for propensity score based on 41 confounders. The mean follow-up period was 2.5 ± 2.1 years (up to 8.3 years) with 98% completeness.ResultsThere were 323 patients who received a bioprosthetic valve (group B), and 168 patients who received a mechanical valve (group M). There was no significant difference for in-hospital death rate between groups (group B: 12.1%; group M: 8.9%; P = .29). The overall survival rate at 5 years after surgery was 39.3% in group B and 50.4% in group M (P = .42). Freedom from reoperation at 5 years was 97.1% in group B and 97.8% in group M (P = .88). On propensity-score adjusted analyses, there were no significant differences in overall survival between groups.ConclusionsThere were no significant differences in overall survival between bioprosthetic valves and mechanical valves in patients on hemodialysis undergoing AVR.

【 授权许可】

Unknown