Daijiro Hori1, Sho Kusadokoro2, Yuichiro Kitada2, Naoyuki Kimura2, Harunobu Matsumoto2, Koichi Yuri2, Atsushi Yamaguchi2. 1. Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan. dhori07@jichi.ac.jp. 2. Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan.
Abstract
OBJECTIVE: The purpose of this study was to evaluate the outcomes of prosthesis selection in hemodialysis patients undergoing valve replacement for aortic valve stenosis. METHODS: From July 2008 to December 2016, 76 patients on hemodialysis underwent aortic valve replacement for aortic valve stenosis. Of these patients, 30 patients were treated by a mechanical valve and 46 patients were treated by a bioprosthesis. Early outcomes and long-term outcomes were compared. RESULTS: The mean age of the patients treated by a mechanical valve was younger than the patients treated by a bioprosthesis (p < 0.001). There were no significant differences in in-hospital mortality (p = 0.52). For the long-term outcomes, complications associated with bleeding were higher in patients who received a mechanical valve (p = 0.032). However, no significant difference was observed in mortality (p = 0.65) and major adverse cardiovascular cerebrovascular event (MACCE: p = 0.59). The actuarial survival rate with a mechanical valve was 56.7% (95% CI 36.4-72.8%) at 3 years and 48.6% (95% CI 28.9-65.8%) at 5 years. The actuarial survival rate with a bioprosthesis was 61.2% (95% CI 44.0-74.5%) at 3 years and 39.5% (95% CI 20.9-57.8%) at 5 years. No patients from both groups needed redo surgery for valvular deterioration. Further, there was no significant difference in long-term mortality (p = 0.91) and MACCE (p = 0.63) in a propensity score-matched patient comparison. CONCLUSIONS: Although bleeding complications were higher in patients who received a mechanical valve, there were no significant differences in early- and long-term mortality, and MACCE between patients treated by a mechanical valve and a bioprosthesis.
OBJECTIVE: The purpose of this study was to evaluate the outcomes of prosthesis selection in hemodialysis patients undergoing valve replacement for aortic valve stenosis. METHODS: From July 2008 to December 2016, 76 patients on hemodialysis underwent aortic valve replacement for aortic valve stenosis. Of these patients, 30 patients were treated by a mechanical valve and 46 patients were treated by a bioprosthesis. Early outcomes and long-term outcomes were compared. RESULTS: The mean age of the patients treated by a mechanical valve was younger than the patients treated by a bioprosthesis (p < 0.001). There were no significant differences in in-hospital mortality (p = 0.52). For the long-term outcomes, complications associated with bleeding were higher in patients who received a mechanical valve (p = 0.032). However, no significant difference was observed in mortality (p = 0.65) and major adverse cardiovascular cerebrovascular event (MACCE: p = 0.59). The actuarial survival rate with a mechanical valve was 56.7% (95% CI 36.4-72.8%) at 3 years and 48.6% (95% CI 28.9-65.8%) at 5 years. The actuarial survival rate with a bioprosthesis was 61.2% (95% CI 44.0-74.5%) at 3 years and 39.5% (95% CI 20.9-57.8%) at 5 years. No patients from both groups needed redo surgery for valvular deterioration. Further, there was no significant difference in long-term mortality (p = 0.91) and MACCE (p = 0.63) in a propensity score-matched patient comparison. CONCLUSIONS: Although bleeding complications were higher in patients who received a mechanical valve, there were no significant differences in early- and long-term mortality, and MACCE between patients treated by a mechanical valve and a bioprosthesis.
Entities:
Keywords:
Aortic valve replacement; Aortic valve stenosis; Hemodialysis; Prosthesis; Surgery
Authors: Martijn W A van Geldorp; W R Eric Jamieson; A Pieter Kappetein; Jian Ye; Guy J Fradet; Marinus J C Eijkemans; Gary L Grunkemeier; Ad J J C Bogers; Johanna J M Takkenberg Journal: J Thorac Cardiovasc Surg Date: 2009-02-25 Impact factor: 5.209
Authors: Kevin S Kim; Emilie P Belley-Côté; Saurabh Gupta; Arjun Pandey; Ali Alsagheir; Ahmad Makhdoum; Graham McClure; Brooke Newsome; Sophie W Gao; Matthias Bossard; Tetsuya Isayama; Yasuhisa Ikuta; Michael Walsh; Amit X Garg; Gordon H Guyatt; Richard P Whitlock Journal: Can J Surg Date: 2022-07-12 Impact factor: 2.840