Contemporary perioperative results of heart valve replacement in dialysis patients: analysis of 1,616 patients from the Japan adult cardiovascular surgery database.

BACKGROUND AND AIM OF THE STUDY: The study aim was to collect Japanese data and stratify the operative risk of valve replacement in patients with end-stage renal failure who required dialysis.

METHODS: The Japan Adult Cardiovascular Surgery Database from 167 participating sites was used; a total of 1,616 records obtained between January 2004 and December 2011 was analyzed. Aortic valve replacement was performed in 1,390 of these patients (86%), mitral valve replacement in 372 (23%), and tricuspid valve replacement in eight (0.5%).

RESULTS: The operative mortality and morbidity were 13.7% and 32%, respectively. Mechanical valves were frequently used even in patients aged >65 years (49%). Patients with bioprosthetic valves were significantly older and more likely to have comorbidities than those with mechanical valves. The operative mortality (11% versus 17%, p <0.01) and major morbidity (29% versus 37%, p <0.01) were significantly higher in patients with bioprosthetic valves. In multivariate analysis, the type of valve prosthesis was not predictive of death. Significant variables with high odds ratios included chronic lung disease (3.72), peripheral artery disease (2.24), and urgent/emergency status (2.33).

CONCLUSION: The contemporary results of valve replacement for dialysis patients obtained in Japan are acceptable. Mechanical valves are frequently used, regardless of patient age. From the standpoint of an operative risk model, careful preoperative assessment is more important than the choice of valve prosthesis in dialysis patients.