NDT Advance Access published online on July 7, 2008
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfn337
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Prosthesis type has minimal impact on survival after valve surgery in patients with moderate to end-stage renal failure
1 Department of Cardiothoracic Surgery 2 Division of Nephrology, Mount Sinai School of Medicine, New York, NY, USA
Correspondence and offprint requests to: Farzan Filsoufi, Department of Cardiothoracic Surgery, Mount Sinai School of Medicine, 1190 Fifth Avenue, Box 1028, New York, NY 10029, USA. Tel: +1-212-659-6813; Fax: +1-212-659-6818; E-mail: Farzan.filsoufi{at}mountsinai.org
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Abstract |
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Background. Few previous studies have reported on the outcome of patients with renal failure (RF) undergoing valvular surgery, particularly with regard to choice of valve prosthesis.
Methods. We retrospectively analyzed prospectively collected data from 155 patients with RF (mean age 62 ± 14, 42% female) who underwent left-sided valve surgery from January 1998 to December 2006. Patients were divided into two groups: Group 1 (non-dialysis-dependent renal failure (NDRF); creatinine >2.5 mg/dl; n = 47, 40%) and Group 2 (renal failure dialysis (DRF); n = 108, 60%). Mechanical valves were implanted in 50 (32%) patients and bioprostheses in 63 (41%). Isolated mitral valve reconstruction was performed in 27% (n = 42) of patients. Outcome measures included hospital mortality, major postoperative complications, length of hospital stay, discharge planning and late survival.
Results. The overall hospital mortality was 19.3% (n = 30) and was not different between Groups 1 (23%) and 2 (18%). Ejection fraction, peripheral vascular disease, aortic valve replacement and reoperation were independent predictors of hospital mortality. One- and five-year survival rates were 74.4 ± 7.8% and 53.1 ± 10.1% in Group 1 and 75.8 ± 4.6% and 49.1 ± 7.1% in Group 2 (P = ns), respectively. According to the type of prostheses, hospital mortality and freedom from reoperation were similar in patients with mechanical and biological valves. Five-year survival rate was 51 ± 10.7 for biological valves versus 55 ± 8.4 for mechanical valves (P = ns).
Conclusions. Hospital mortality and morbidity remain high in patients with RF undergoing valvular surgery and it is not different in NDRF and DRF patients. This study suggests that the type of valve prosthesis does not appear to have an impact on early and late survival but is limited by sample size. It may be that bioprostheses should be more widely used in patients with RF requiring valve replacement.
Keywords: mortality; prosthesis; renal failure; survival
Received for publication: 8. 1.08
Accepted in revised form: 22. 5.08