Outcomes of valve replacement with mechanical prosthesis versus bioprosthesis in dialysis patients: A 16-year multicenter experience

The Journal of Thoracic and Cardiovascular Surgery

Nobuhiko Mukohara¹  Hidefumi Obo²  Kunio Gan³  Yuki Ikeno⁴  Kazunori Yoshida⁵  Yoshiaki Fukumura⁶  Satoshi Tobe⁷ 

[1] Department of Cardiovascular Surgery, Hyogo Brain and Heart Center at Himeji, Himeji, Japan;Department of Cardiovascular Surgery, Kakogawa City Hospital, Kakogawa, Japan;Department of Cardiovascular Surgery, Kita-Harima Medical Center, Ono, Japan;Department of Cardiovascular Surgery, Kobe University, Kobe, Japan;Department of Cardiovascular Surgery, Nishinomiya Watanabe Cardiovascular Center, Nishinomiya, Japan;Department of Cardiovascular Surgery, Tokushima Red Cross Hospital, Tokushima, Japan;Department of Cardiovasular Surgery, Akashi Medical Center, Akashi, Japan

关键词: aortic valve replacement;    mitral valve replacement;    hemodialysis;    end-stage renal failure;   

DOI  :  10.1016/j.jtcvs.2018.11.089

学科分类：心脏病和心血管学

来源: Mosby, Inc.

【 摘 要 】

ObjectiveTo evaluate the long-term outcomes of heart valve replacement with mechanical prosthesis (MP) versus bioprosthesis (BP) in patients on dialysis.MethodsA retrospective review was performed at 7 hospitals. Patients on dialysis who underwent valve replacement were included. Survival, reoperation, bleeding, and embolic events were compared across the MP and BP groups.ResultsBetween April 2000 and April 2016, 312 patients on dialysis were enrolled in our study (MP: 94 patients [30.1%], BP: 218 patients [69.9%]). Mean follow-up was 3.4 ± 3.6 years. Five-year and 10-year survival rates were similar in both groups (MP: 57.4 ± 5.5% at 5 years and 46.3 ± 6.4% at 10 years, BP: 50.2 ± 4.1% at 5 years and 38.8 ± 4.5% at 10 years, P = .305). Multivariate Cox hazard analysis demonstrated that diabetic nephropathy (hazard ratio [HR], 1.90; 95% confidence interval [CI], 1.31-2.73, P P = .001), and mitral valve replacement (HR, 2.36; 95% CI, 1.58-3.49, P P = .007). Freedom from valve-related reoperation or hemorrhagic events was similar across both groups.ConclusionsValve selection was not associated with late survival outcomes in patients on dialysis. However, BP may have an advantage in preventing embolic events without increasing the incidence of valve-related reoperation when compared with MP.

【 授权许可】

Unknown