The long-term survival and reoperation rate in chronic renal failure (CRF) on hemodialysis
(HD) patients after aortic valve/root replacement (AVR/ARR) with a stentless bioprosthesis
is unknown. From 1992–2015, 1941 patients underwent AVR/ARR with stentless valve for
primary indications of aortic stenosis/insufficiency, root aneurysm, and acute type
A aortic dissection, including 93 CRF-HD (64 new-onset postoperative HD, and 29 preoperative
HD) and 1848 non-CRF-HD. Data was obtained from the STS database, retrospective chart
review, administered surveys and national death index data. Compared to the non-CRF-HD
group, the CRF-HD group had significantly higher incidence of diabetes mellitus (28
vs 18%), CAD (49 vs 38%), COPD (31 vs 16%), NYHA class IV (12 vs 4%), atrial fibrillation
(24 vs 12%), and previous cardiac surgery (27 vs 16%). Postoperatively, CRF-HD group
had a higher reoperation for bleeding (10 vs 4%), length of hospital stays (20 vs
7 days), and operative mortality (23 vs 2.3%), all p < 0.01. The odds ratio of CRF-HD
for operative mortality was 8.97. The long-term survival was worse in CRF-HD group
than that in non-CRF-HD group [8-year survival: 31% vs 70%, p < 0.0001]. The hazard
ratio of CRF-HD for long-term mortality was 2.4. The 10-year cumulative reoperation
rate for structural valve deterioration in the CRF-HD group was 6.0% vs 5.0% in the
non-CRF-HD group, p = 0.74. Surgeons should consider poor short- and long-term outcomes
of patients with high risk of being on dialysis when offering aortic valve/root replacement.
Bioprosthesis could be a good option in this patient population.
Graphical Abstract
Graphical Abstract
Keywords
Abbreviations:
ARR (aortic root replacement), AVR (aortic valve replacement), CRF (chronic renal failure), CRF-HD (chronic renal failure on hemodialysis), ESRD (end stage renal disease), HD (hemodialysis), SVD (structural valve deterioration), TAVR (transcatheter aortic valve replacement)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: June 04, 2021
Footnotes
Oral presentation: AHA 2019
Date and Number of IRB Approval: July 10, 2013; HUM00076499; a waiver of informed consent was obtained.
Meeting Presentation: AHA Scientific Sessions 2019, Philadelphia, Pennsylvania
Funding: Dr. Yang is supported by the NHLBI of NIH K08HL130614, R01HL141891, and R01HL151776, Phil Jenkins and Darlene & Stephen J. Szatmari Funds.
Conflicts of Interest: Dr. Deeb is an advisor for Medtronic. Dr. Patel is a consultant for WL Gore, Medtronic, and Terumo.
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© 2021 Elsevier Inc. All rights reserved.
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Access this article on ScienceDirectLinked Article
- Commentary: Outcomes of Surgical Aortic Valve or Root Replacement in Patients on Hemodialysis: Lessons Learned and Remaining ChallengesSeminars in Thoracic and Cardiovascular SurgeryVol. 34Issue 3
- PreviewEnd-stage renal disease (ESRD) patients undergoing hemodialysis (HD) are at high-risk when undergoing surgical aortic valve replacement (SAVR). After SAVR, the cardiovascular disease and renal comorbidities in these HD patients increase the risk of 30-day mortality by up to 15-17%, approximately 40% at 3 years, and 60% at 5 years.1–3 Thus, it is essential to carefully assess preoperative comorbidities of each patient and to optimize prosthetic valve selection and surgical procedure. This will minimize the deleterious effect of cardiopulmonary bypass (CPB) and HD-associated postoperative morbidities and increase survival and quality of life.
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- Preview
- Commentary: Stentless AVR in dialysis patients – another hand on the elephantSeminars in Thoracic and Cardiovascular SurgeryVol. 34Issue 3
- PreviewThere is a parable from the Indian subcontinent that a group of blind men approach an elephant and each of them has a dramatically different appreciation depending on which part of the elephant they are touching (tusk, ear, tail, trunk etc.). In the present report the authors make a valiant effort to understand the performance of the Medtronic Freestyle heterograft (Medtronic, Minneapolis MN) in the setting of Hemodialysis (HD) patients at their center and found excellent durability.1 Anecdotally, at our center we have also found the Freestyle valve a durable option for root replacement; and a recent review of Medicare recipients undergoing root replacement found excellent mid-term results.
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- Preview
