Mid-term results of surgical aortic valve replacement with bioprostheses in hemodialysis patients. (June 2022)

• Record Type: Journal Article
• Authors: Shibasaki, Ikuko; Fukuda, Taira; Ogawa, Hironaga; Tsuchiya, Go; Takei, Yusuke; Seki, Masahiro; Kato, Takashi; Kanazawa, Yuta; Saito, Shunsuke; Kuwata, Toshiyuki; Yamada, Yasuyuki; Haruyama, Yasuo; Fukuda, Hirotsugu
• Is Part Of: IJC heart & vasculature. Volume 40(2022)
• Publication Date: 2022-06
• Subjects: Hemodialysis -- Surgical aortic valve replacement -- Bioprostheses -- Aortic valve stenosis; HD hemodialysis -- HF heart failure -- MI myocardial infarction -- AS aortic stenosis -- SAVR surgical aortic valve replacement -- TAVR transcatheter aortic valve replacement -- SAVR-BP SAVR with bioprostheses -- AXA axillary artery -- CPB cardiopulmonary bypass -- CP cold blood cardioplegia -- ICU intensive care unit -- CABG coronary artery bypass graft -- APACHE Acute Physiology and Chronic Health Evaluation -- SOFA Sequential Organ Failure Assessment -- SAPS II Simple Acute Physiology Score II -- SD standard deviation -- ECMO extracorporeal membrane oxygenation -- Af atrial fibrillation -- MACCE major adverse cardiovascular and cerebrovascular events -- LV left ventricular -- Dd diastolic diameter -- Ds systolic diameter -- IABP intra-aortic balloon pumping -- LVEF left ventricle ejection fraction -- 95% CI confidence interval -- HR hazard ratio -- LOS low output syndrome; Cardiovascular system -- Diseases -- Periodicals; Cardiovascular system -- Pathophysiology -- Periodicals; 616.1005
• DOI: 10.1016/j.ijcha.2022.101030
• Languages: English
• ISSNs: 2352-9067

Abstract

Highlights: HD patients underwent SAVR-BP for AS (hospital mortality, 8.8%; 5-year mortality, 42.1%). Preoperative risk factors for 5-year mortality: age, hyperlipidemia, LVDd, LVDs, and Japan SCORE. Postoperative risk factors for 5-year mortality: length of ICU stay, and albumin level at discharge. Abstract: Background: Limited studies have assessed the factors affecting prognosis in hemodialysis (HD) patients who undergo surgical aortic valve replacement with a bioprostheses (SAVR-BP). This study aimed to evaluate the outcomes of HD patients who had undergone SAVR-BP for aortic stenosis (AS) and identify the risk factors for mortality. Methods: This retrospective study included 57 HD patients who had undergone SAVR-BP for AS between July 2009 and December 2020. Multivariate logistic regression was used to predict factors associated with mid-term outcomes and death or survival. Kaplan − Meier curves were also generated for mid-term survival. Results: The in-hospital mortality rate was 8.8%, and the 5-year mortality rate was 42.1%. The independent predictors of 5-year mortality were preoperative age (hazard ratio [HR], 1.57; 95% confidence interval [CI], 1.175–2.083, p = 0.002), hyperlipidemia (HR, 0.02; 95% CI, 0.002–0.297, p = 0.004), left ventricular diastolic diameter (HR, 1.74; 95% CI, 1.142–2.649, p = 0.010), left ventricular systolic diameter (HR, 0.61; 95% CI, 0.392–0.939, p = 0.025), and Japan SCORE (HR, 1.28; 95% CI, 1.052–1.563, p = 0.014). The postoperative predictors included intensive care unit stay (HR, 1.11; 95% CI, 1.035–1.194, p = 0.004) and albumin level (HR, 0.38; 95% CI, 0.196–0.725, p = 0.003). Conclusions: The 5-year prognosis of HD patients undergoing SAVR may be improved by early diagnosis (before the occurrence of LV hypertrophy/enlargement) and nutritional management with oral intake to alleviate postoperative hypoalbuminemia. Registration number of clinical studies: UMIN000047410.