Long-term Results of Mechanical and Biological Heart Valves in Dialysis and Non-Dialysis Patients

Abstract

Introduction: We wanted to answer the question whether biological heart valves are inferior compared to mechanical heart valves in end-stage renal disease (ESRD) patients. Methods: Between 01/1996 und 12/2006, 44 of 3293 patients undergoing aortic valve replacement (AVR) in a single institution suffered from dialysis-dependent ESRD and underwent a follow-up investigation after 1.9 years (median). Twelve (28.9 %) of these patients received a biological, 32 (71.1 %) of these patients a mechanical aortic valve prosthesis. To evaluate a possible influence of the valve type (biological/mechanical) on survival, uni- and multivariate logistic regression was used. Results: ESRD patients after AVR had a relatively poor short-term (30-day mortality: 22.7 %) and long-term survival (median survival time: 24.7 months; 95 % CI: 0.2–47.7 months), irrespective of the type of heart valve prosthesis (hazard ratio for mortality depending on heart valve type in dialysis patients: 1.31, p = 0.400). Dialysis-dependent patients were not reoperated due to valve-related reasons. Conclusions: The long-term survival of dialysis-dependent patients after AVR is low (5-year survival: 29.5 %) irrespective of the type of heart valve prosthesis. Therefore, the use of biological AVR is not contraindicated in this group of patients.

Key words

kidney (includes related subject matter) - heart valve surgery - cardiac - dialysis - end-stage renal disease - aortic valve replacement - biological aortic valve prosthesis - mechanical aortic valve prosthesis - long-term survival - mortality risk factors

References

• 1 Bonow R O, Carabello B, de Leon Jr A C et al. Guidelines for the management of patients with valvular heart disease. Executive summary.  Circul. 1998;  98 1949-1984
• 2 Bonow R O, Carabello B A, Chatterjee K et al. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease.  Circul. 2006;  114 84-231
• 3 Herzog C A, Ma J Z, Collins A J. Long-term survival of dialysis patients in the United States with prosthetic heart valves.  Circul. 2002;  105 1336-1341
• 4 Bechtel J F M, Detter C, Fischlein T et al. Cardiac surgery in patients on dialysis: decreased 30-day mortality, unchanged overall survival.  Ann Thorac Surg. 2008;  85 147-153
• 5 Toumpoulis I K, Chamogeorgakis T P, Angouras D C, Swistel D G, Anagnostopoulos C E, Rokkas C K. Independent predictors for early and long-term mortality after heart valve surgery.  J Heart Valve Dis. 2008;  17 548-556
• 6 Rahmanian P B, Adams D H, Castillo J G, Vassalotti J, Filsoufi F. Early and late outcome of cardiac surgery in dialysis-dependent patients: single-center experience with 245 consecutive patients.  J Thorac Cardiovasc Surg. 2008;  135 915-922
• 7 Tanaka K, Tajima K, Takami Y et al. Early and late outcome of aortic valve replacement in dialysis patients.  Ann Thorac Surg. 2010;  89 65-70
• 8 Kajbaf S, Veinot J P, Ha A, Zimmerman D. Comparison of surgically removed cardiac valves of patients with ESRD with those of the general population.  Am J Kidney Dis. 2005;  46 86-93
• 9 Tarrass F, Benjelloun M, Zamd M et al. Heart valve calcifications in patients with end-stage renal disease: analysis for risk factors.  Nephrology. 2006;  11 494-496
• 10 Maher E R, Curtis J R. Calcific aortic stenosis in chronic renal failure.  Lancet. 1985;  2 1007
• 11 Dahm M, Dohmen G, Prüfer D, Krummenauer F, Hafner G, Oelert H. Determinants of calcium uptake of bovine pericardium for heart valve replacement: results of in vitro studies.  J Heart Valve Dis. 1998;  2 170-173
• 12 Umezu K, Saito S, Yamazaki K, Kawai A, Kurosawa H. Cardiac valvular surgery in dialysis patients: comparison of surgical outcome for mechanical versus bioprosthetic valves.  Gen Thorac Cardiovasc Surg. 2009;  57 197-202
• 13 Filsoufi F, Chikwe J, Castillo J G, Rahmanian P B, Vassalotti J, Adams D H. Prosthesis type has minimal impact on survival after valve surgery in patients with moderate to end-stage renal failure.  Nephrol Dial Transplant. 2008;  23 3613-3621
• 14 Kaplon R J, Cosgrove 3rd D M, Gillinov A M, Lytle B W, Blackstone E H, Smedira N G. Cardiac valve replacement in patients on dialysis: influence of prosthesis on survival.  Ann Thorac Surg. 2002;  73 696-697
• 15 Toole J M, Stroud M R, Kratz J M, Crumbley A J, Crawford Jr F A, Ikonomidis J S. Valve surgery in renal dialysis patients.  J Heart Valve Dis. 2006;  15 453-458
• 16 Lucke J C, Samy R N, Atkins B Z et al. Results of valve replacement with mechanical and biological prostheses in chronic renal dialysis patients.  Ann Thorac Surg. 1997;  64 129-132
• 17 Hijashita R, Takeuchi Y. Cardiac valve replacement in patients on dialysis.  Ann Thorac Surg. 2002;  73 696-697
• 18 Hahn H S, Maze S S. Rapid bioprosthetic valve degeneration in a patient undergoing hemodialysis.  Ann Int Med. 2000;  132 847
• 19 Briand M, Pibarot P, Despres J P et al. Metabolic syndrome is associated with faster degeneration of bioprosthetic valves.  Circul. 2006;  114 (Suppl. I) I-512-I-517
• 20 Ohara T, Hashimoto Y, Matsumura A, Suzuki M, Isobe M. Accelerated progression and morbidity in patients with aortic stenosis on chronic dialysis.  Circ J. 2005;  69 1535-1539
• 21 Torun D, Sezer S, Baltali M et al. Association of cardiac valve calcification and inflammation in patients on hemodialysis.  Ren Fail. 2005;  27 221-226
• 22 Adeney K L, Siscovick D S, Ix J H et al. Association of serum phosphate with vascular and valvular calcifications in moderate CKD.  J Am Soc Nephrol. 2009;  20 381-387
• 23 Kogan A, Medalion B, Kornowski R et al. Cardiac surgery in patients on chronic hemodialysis: short and long term survival.  Thorac Cardiovasc Surg. 2008;  56 123-127
• 24 Brinkman W T, Williams W H, Guyton R A, Jones E L, Craver J M. Valve replacement in patients on chronic renal dialysis: implications for valve prosthesis selection.  Ann Thorac Surg. 2002;  74 37-42
• 25 Frenken M, Krian A. Cardiovascular operations in patients with dialysis-dependent renal failure.  Ann Thorac Surg. 1999;  68 887-993
• 26 Boku N, Masuda M, Eto M, Nishida T, Morita S, Tominaga R. Risk evaluation and midterm outcome of cardiac surgery in patients on dialysis.  Asia Cardiovasc Thorac Ann. 2007;  15 19-23