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Mizote I, Nakamura D, Maeda K, Dohi T, Shimamura K, Kawamura A, Yamashita K, Matsuhiro Y, Kosugi S, Sugae H, Takeda Y, Sakata Y. Five-Year Transcatheter Aortic Valve Replacement Outcomes in Chronic Hemodialysis vs. Non-Hemodialysis Patients Using Balloon-Expandable Devices. Circ J 2024:CJ-24-0050. [PMID: 38735703 DOI: 10.1253/circj.cj-24-0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
BACKGROUND Based on the results of a clinical trial in Japan, transcatheter aortic valve replacement (TAVR) for hemodialysis (HD) patients gained approval; however, mid-term TAVR outcomes and transcatheter aortic valve (TAV) durability in HD patients remain unexplored.Methods and Results: We analyzed background, procedural, in-hospital outcome, and follow-up data for 101 HD patients and 494 non-HD patients who underwent TAVR using balloon-expandable valves (SAPIEN XT or SAPIEN 3) retrieved from Osaka University Hospital TAVR database. Periprocedural mortality and TAVR-related complications were comparable between HD and non-HD patients. However, Kaplan-Meier analysis revealed that HD patients had significantly lower survival rates (log-rank test, P<0.001). In addition, HD patients had significantly higher rates of severe structural valve deterioration (SVD) than non-HD patients (Gray test, P=0.038). CONCLUSIONS TAVR in HD patients had comparable periprocedural mortality but inferior mid-term survival and TAV durability than in non-HD patients. Indications for TAVR in younger HD patients should be carefully determined, considering the possibility of a TAV-in-TAV procedure when early SVD occurs.
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Affiliation(s)
- Isamu Mizote
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Daisuke Nakamura
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Koichi Maeda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Tomoharu Dohi
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Kazuo Shimamura
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Ai Kawamura
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Kizuku Yamashita
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Yutaka Matsuhiro
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Shumpei Kosugi
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Hiroki Sugae
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Yasuharu Takeda
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
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Yang KJ, Fu HY, Chang CJ, Wang TC, Wang CH, Chou NK, Wu IH, Hsu RB, Huang SC, Yu HY, Chen YS, Chi NH. Long-term outcomes of mitral valve replacement in dialysis patients: evidence from a nationwide database. Int J Surg 2023; 109:3778-3787. [PMID: 37678297 PMCID: PMC10720870 DOI: 10.1097/js9.0000000000000684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/04/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND To compare the late outcomes between mechanical and bioprostheses after isolated mitral valve replacement (MVR) in dialysis-dependent patients. METHODS A nationwide propensity-matched retrospective cohort study was conducted involving dialysis patients who underwent primary mitral replacement between 2001 and 2018. Ten-year postoperative outcomes were compared between mitral bioprosthesis and mechanical prosthesis using the Cox proportional hazard model and restricted mean survival time (RMST). RESULTS The all-cause mortality was 20.8 and 13.0 events per 100 person-years, with a 10-year RMST of 7.40 and 7.31 years for bioprosthesis and mechanical prosthesis, respectively. Major bleeding was the most common adverse event for both bioprosthesis and mechanical prosthesis, with an incidence rate of 19.5 and 19.1 events per 100 person-years, respectively. The incidence of valve reoperation was higher among those who received bioprosthesis (0.55 events per 100 person-years). After 1:1 matching, the all-cause mortality was 15.45 and 14.54 events per 100 person-years for bioprosthesis and mechanical prosthesis, respectively. The RMST at 10 years was comparable between the two groups after matching (5.10 years for bioprosthesis vs. 4.59 years for mechanical prosthesis), with an RMST difference of -0.03. Further, no difference was observed in the incidence of major adverse valve-related events between bioprosthesis and mechanical valves. However, bioprosthesis was associated with a higher incidence of mitral valve reoperation among all major adverse events (RMST difference -0.24 years, 95% CI -0.48 to -0.01, P =0.047). CONCLUSIONS This study found no association between valve selection and long-term survival outcomes in dialysis patients after MVR. However, bioprosthetic valves may be associated with a slightly higher incidence of reoperation, while other valve-related adverse events, including major bleeding and stroke, were comparable between the two types of prostheses.
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Affiliation(s)
- Kelvin J. Yang
- Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei
| | - Hsun-Yi Fu
- Department of Cardiovascular Surgery, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu
| | - Chia-Jui Chang
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University
- Department of Pharmacy, National Taiwan University Cancer Center
| | - Ting-Chuan Wang
- Health Data Research Center, National Taiwan University, Taipei, Taiwan
| | - Chih-Hsien Wang
- Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei
| | - Nai-Kuan Chou
- Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei
| | - I-Hui Wu
- Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei
| | - Ron-Bin Hsu
- Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei
| | - Shu-Chien Huang
- Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei
| | - Hsi-Yu Yu
- Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei
| | - Yih-Sharng Chen
- Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei
| | - Nai-Hsin Chi
- Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei
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Shibasaki I, Fukuda T, Ogawa H, Tsuchiya G, Takei Y, Seki M, Kato T, Kanazawa Y, Saito S, Kuwata T, Yamada Y, Haruyama Y, Fukuda H. Mid-term results of surgical aortic valve replacement with bioprostheses in hemodialysis patients. IJC HEART & VASCULATURE 2022; 40:101030. [PMID: 35434259 PMCID: PMC9011164 DOI: 10.1016/j.ijcha.2022.101030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 11/23/2022]
Abstract
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.
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.
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Go S, Furukawa T, Yamada K, Mochizuki S, Hiraoka T, Takahashi S. Strict control of phosphorus concentration of hemodialysis patients may decrease structural valve deterioration after aortic valve replacement. Gen Thorac Cardiovasc Surg 2021; 70:547-552. [PMID: 34797477 DOI: 10.1007/s11748-021-01739-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 11/08/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The number of hemodialysis patients requiring aortic valve replacement (AVR) is increasing. Although bioprosthetic valves are increasingly popular, they are associated with a risk of structural valve deterioration (SVD). The aim of this study is to examine the outcomes of bioprosthetic valves in hemodialysis patients undergoing AVR and to identify treatment strategies that can decrease the risk of SVD. METHODS Between February 2010 and November 2019, 61 patients on hemodialysis underwent AVR using bioprosthetic valves at our hospital. Five patients died while still in the hospital. Kaplan-Meier estimates of overall survival and univariate Cox proportional hazards regression analyses were performed for the remaining 56 patients. RESULTS During follow-up, there were six SVD events (10.7%) related to the bioprosthetic valves. The survival rate was 67.9% at 3 years and 39.5% at 5 years. In all SVD cases, SVD was caused by aortic stenosis. The mean interval between AVR and the discovery of SVD was 41.5 months. The SVD-free rate was 88.6% at 3 years and 65.3% at 5 years. Preoperative phosphorus levels are associated with SVD risk. High preoperative phosphorus concentration is associated with elevated SVD risk. CONCLUSIONS In this study, we determined that the risk of SVD can be influenced by preoperative phosphorus level. Strict control of the phosphorus concentration of hemodialysis patients may decrease structural valve deterioration after aortic valve replacement.
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Affiliation(s)
- Seimei Go
- Department of Cardiovascular Surgery, Hiroshima University, Kasumi 1-2-3, Minamiku, Hiroshima, Hiroshima, Japan.
| | - Tomokuni Furukawa
- Department of Cardiovascular Surgery, Akane-Foundation Tsuchiya General Hospital, Hiroshima, Japan
| | - Kazunori Yamada
- Department of Cardiovascular Surgery, Akane-Foundation Tsuchiya General Hospital, Hiroshima, Japan
| | - Shingo Mochizuki
- Department of Cardiovascular Surgery, Akane-Foundation Tsuchiya General Hospital, Hiroshima, Japan
| | - Toshifumi Hiraoka
- Department of Cardiovascular Surgery, Akane-Foundation Tsuchiya General Hospital, Hiroshima, Japan
| | - Shinya Takahashi
- Department of Cardiovascular Surgery, Hiroshima University, Kasumi 1-2-3, Minamiku, Hiroshima, Hiroshima, Japan
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Ito Y, Nakamura Y, Yasumoto Y, Yoshiyama D, Kuroda M, Nishijima S, Nakayama T, Tsuruta R, Narita T. Surgical outcomes of minimally invasive aortic valve replacement via right mini-thoracotomy for hemodialysis patients. Gen Thorac Cardiovasc Surg 2021; 70:439-444. [PMID: 34676484 DOI: 10.1007/s11748-021-01720-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 10/10/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Minimally invasive valve surgery has become increasingly accepted as an alternative to conventional median sternotomy in low-risk patients. However, there have been no reports regarding the outcomes of this procedure on high-risk hemodialysis patients. The purpose of this investigation was to assess the surgical outcomes of minimally invasive aortic valve replacement (AVR) via right mini-thoracotomy (MIAVR) in hemodialysis patients compared with those of conventional AVR (CAVR) via full sternotomy. METHODS Two hundred and seventy-four patients underwent isolated AVR for severe AS, and 42 hemodialysis patients were included in this study. MIAVR was performed in 17 cases and CAVR in 25 cases. We compared the short-term surgical outcome among the two groups. RESULTS There was no difference in the aortic cross-clamp or cardiopulmonary bypass time. However, the procedure time was significantly shorter in the MIAVR group. Patients in the MIAVR group had less bleeding and a smaller amount of transfused red blood cells. There were four hospital deaths (18.2%) in the CAVR group. For postoperative complications, there were 2 (9.1%) cerebrovascular incidents, 2 (9.1%) cases of respiratory failure, 1 (4.5%) re-exploration for bleeding in CAVR group. The postoperative ventilation time was significantly shorter in the MIAVR group. There was no difference in the length of postoperative intensive care unit stay or of postoperative hospital stay. CONCLUSION The surgical outcomes of MIAVR in hemodialysis patients were acceptable, with a low incidence of morbidity, reasonable lengths of hospital stay, and no mortality among the patients studied.
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Affiliation(s)
- Yujiro Ito
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital, 107-1 Kanegasaku, Matsudo-shi, Chiba, 270-2251, Japan
| | - Yoshitsugu Nakamura
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital, 107-1 Kanegasaku, Matsudo-shi, Chiba, 270-2251, Japan.
| | - Yuto Yasumoto
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital, 107-1 Kanegasaku, Matsudo-shi, Chiba, 270-2251, Japan
| | - Daiki Yoshiyama
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital, 107-1 Kanegasaku, Matsudo-shi, Chiba, 270-2251, Japan
| | - Miho Kuroda
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital, 107-1 Kanegasaku, Matsudo-shi, Chiba, 270-2251, Japan
| | - Shuhei Nishijima
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital, 107-1 Kanegasaku, Matsudo-shi, Chiba, 270-2251, Japan
| | - Taisuke Nakayama
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital, 107-1 Kanegasaku, Matsudo-shi, Chiba, 270-2251, Japan
| | - Ryo Tsuruta
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital, 107-1 Kanegasaku, Matsudo-shi, Chiba, 270-2251, Japan
| | - Takuya Narita
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital, 107-1 Kanegasaku, Matsudo-shi, Chiba, 270-2251, Japan
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Kinoshita T, Yoshida K, Suzuki T, Asai T. Longitudinal Hemodynamics of Aortic Bioprosthetic Valve in Hemodialysis Patients. Semin Thorac Cardiovasc Surg 2021; 34:1182-1192. [PMID: 34508813 DOI: 10.1053/j.semtcvs.2021.08.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 08/31/2021] [Indexed: 11/12/2022]
Abstract
We examined the hemodynamic profile of bioprosthetic aortic valves in patients on hemodialysis (HD), longitudinally, and assess the incidence of adverse changes detected by echocardiography. Of 1,146 consecutive patients with severe aortic stenosis who underwent bioprosthetic aortic valve replacement (AVR), 148 patients had end-stage renal disease requiring HD. Each patient on HD was matched one-to-one with a non-HD patient on the basis of propensity scores. The mean follow-up period was 3.3 years for the HD group and 5.9 years for the non-HD group. Follow-up information was available for 95.2%. Postoperative trends of valve hemodynamics derived from linear mixed-effect models showed significant group vs time interactions between the two groups. Stable hemodynamics was consistently observed in the non-HD group, whereas the HD group showed a decrease of -0.06 cm2/y (95% confidence interval (CI), -0.10 to -0.02) in effective orifice area, an increase of 0.8 mm Hg/year (95% CI, 0.4-1.1) in mean pressure gradient, and an increase of 0.08 m/s/year (95%CI, 0.02-0.13) in peak velocity. Cumulative incidence function of SVD more than stage 2 was significantly higher in the HD group (13.1% vs 3.1% at 5 years, Gray test p = 0.01). In a multivariable Fine-Gray analysis, diabetes was independently associated with SVD more than stage 2 in the HD group (subhazard ratio, 1.91; 95% CI, 1.25-2.89; p = 0.02). Survival free-from stenotic-type SVD was significantly lower in HD patients undergoing bioprosthetic AVR. Diabetes was independently associated with postoperative stenotic-type SVD in HD patients.
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Affiliation(s)
- Takeshi Kinoshita
- Division of Cardiovascular Surgery, Shiga University of Medical Science, Otsu, Japan.
| | - Kumi Yoshida
- Department of Clinical Engineering, Shiga University of Medical Science, Otsu, Japan
| | - Tomoaki Suzuki
- Division of Cardiovascular Surgery, Shiga University of Medical Science, Otsu, Japan
| | - Tohru Asai
- Division of Cardiovascular Surgery, Shiga University of Medical Science, Otsu, Japan; Department of Cardiovascular Surgery, Juntendo University, Tokyo, Japan
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Bando K. Commentary: Outcomes of Surgical Aortic Valve or Root Replacement in Patients on Hemodialysis: Lessons Learned and Remaining Challenges. Semin Thorac Cardiovasc Surg 2021; 34:890-891. [PMID: 34320392 DOI: 10.1053/j.semtcvs.2021.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 07/20/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Ko Bando
- Department of Cardiac Surgery, The Jikei University School of Medicine, Tokyo, Japan.
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Malik A, Longi F, Naeem A, Clemence JJ, Makkinejad A, Norton E, Wu X, Patel HJ, Deeb GM, Yang B. Outcomes in Patients With Chronic Renal Failure on Hemodialysis After Aortic Valve or Root Replacement. Semin Thorac Cardiovasc Surg 2021; 34:880-888. [PMID: 34098120 PMCID: PMC8643369 DOI: 10.1053/j.semtcvs.2021.05.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 05/21/2021] [Indexed: 11/11/2022]
Abstract
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.
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Affiliation(s)
- Aroosa Malik
- Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan
| | - Faraz Longi
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Michigan
| | - Aroma Naeem
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Michigan
| | | | | | | | - Xiaoting Wu
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Michigan
| | - Himanshu J Patel
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Michigan
| | - G Michael Deeb
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Michigan
| | - Bo Yang
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Michigan..
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Kuroda Y, Marui A, Arai Y, Nagasawa A, Tsumaru S, Arakaki R, Iida J, Wada Y, Tamai Y, Fukushima T, Soga Y. Impact of dialysis in patients undergoing bioprosthetic aortic valve replacement. Interact Cardiovasc Thorac Surg 2021; 33:348-353. [PMID: 33961031 DOI: 10.1093/icvts/ivab106] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/21/2021] [Accepted: 03/24/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To determine the incidence of bioprosthetic structural valve deterioration in dialysis patients undergoing aortic valve replacement compared to that in patients without dialysis. METHODS This single-centre retrospective observational study included 1159 patients who underwent aortic valve replacement using bioprosthetic valves for aortic stenosis and/or regurgitation at our institution between 2007 and 2017 [patients with dialysis (group D, n = 134, 12%) or without dialysis (group N, n = 1025, 88%)]. To adjust for potential differences between groups in terms of initial preoperative characteristics or selection bias, a propensity score analysis was conducted. The final sample that was used in the comparison included 258 patients, as follows: 129 patients with dialysis (group D) and 129 patients without dialysis (group N). The cumulative incidences of all-cause death, cardiac death and moderate or severe structural valve deterioration were estimated using the Kaplan-Meier method. RESULTS Operative mortality was significantly higher in group D than group N (9% vs 0%, P = 0.001). Kaplan-Meier analysis revealed that in group D, the incidence was significantly higher for all-cause death (P < 0.001, 50% vs 18% at 5 years), cardiac death (P = 0.001, 18% vs 5% at 5 years) and moderate or severe structural valve deterioration (P < 0.001, 29% vs 5% at 5 years) compared with group N. CONCLUSIONS The incidence of structural valve deterioration in dialysis patients undergoing aortic valve replacement was higher than that in patients without dialysis. Bioprosthetic valves should be carefully selected in dialysis patients undergoing aortic valve replacement.
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Affiliation(s)
- Yuki Kuroda
- Department of Cardiovascular Surgery, Kokura Memorial Hospital, Fukuoka, Japan
| | - Akira Marui
- Department of Cardiovascular Surgery, Kokura Memorial Hospital, Fukuoka, Japan
| | - Yoshio Arai
- Department of Cardiovascular Surgery, Kokura Memorial Hospital, Fukuoka, Japan
| | - Atsushi Nagasawa
- Department of Cardiovascular Surgery, Kokura Memorial Hospital, Fukuoka, Japan
| | - Shinichi Tsumaru
- Department of Cardiovascular Surgery, Kokura Memorial Hospital, Fukuoka, Japan
| | - Ryoko Arakaki
- Department of Cardiovascular Surgery, Kokura Memorial Hospital, Fukuoka, Japan
| | - Jun Iida
- Department of Cardiovascular Surgery, Kokura Memorial Hospital, Fukuoka, Japan
| | - Yuki Wada
- Department of Cardiovascular Surgery, Kokura Memorial Hospital, Fukuoka, Japan
| | - Yumeka Tamai
- Department of Cardiovascular Surgery, Kokura Memorial Hospital, Fukuoka, Japan
| | - Takashi Fukushima
- Department of Cardiovascular Surgery, Kokura Memorial Hospital, Fukuoka, Japan
| | - Yoshiharu Soga
- Department of Cardiovascular Surgery, Kokura Memorial Hospital, Fukuoka, Japan
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Mentias A, Desai MY, Saad M, Horwitz PA, Rossen JD, Panaich S, Jneid H, Kapadia S, Vaughan-Sarrazin M. Management of Aortic Stenosis in Patients With End-Stage Renal Disease on Hemodialysis. Circ Cardiovasc Interv 2020; 13:e009252. [PMID: 32772570 DOI: 10.1161/circinterventions.120.009252] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with end-stage renal disease on hemodialysis (ESRD-HD) and aortic stenosis have poor prognosis. The role of transcatheter aortic valve replacement (TAVR) in this high-risk population is debated. METHODS We compared the outcomes among ESRD-HD Medicare beneficiaries who were managed with TAVR, surgical AVR (SAVR), or conservative management for aortic stenosis between 2015 and 2017, using overlap propensity score weighting analysis to control for differences in treatment assignment. The primary outcome was all-cause mortality and was compared between treatment groups as well as to age-sex matched mortality for ESRD-HD in the US population. Secondary outcomes included trend of heart failure hospitalizations. RESULTS A total of 8107 ESRD-HD patients with aortic stenosis were included, 4130 (50%) underwent TAVR, 2565 (31.6%) underwent SAVR, and 1412 (17.4%) were managed conservatively. TAVR patients had more comorbidities and higher frailty compared with the other 2 groups. Thirty-day mortality was lower with TAVR compared with SAVR (4.6% versus 12.8%, P<0.01). After a median follow-up of 465 days (interquartile range, 261-759), on overlap propensity score weighting analysis, there was no difference in mortality between TAVR and SAVR (adjusted hazard ratio, 1.02 [95% CI, 0.91-1.15], P=0.7), and mortality was lower with TAVR compared with conservative management (adjusted hazard ratio, 0.53 [95% CI, 0.47-0.60], P<0.001). Standardized mortality ratios with TAVR, SAVR, and conservative management compared with age-sex matched ESRD-HD US population were 1.24, 1.27, and 1.83, respectively. The rate of heart failure admissions declined after TAVR (incidence rate ratio, 0.55 [95% CI, 0.48-0.62], P<0.001) and SAVR (incidence rate ratio, 0.76 [95% CI, 0.65-0.88], P<0.001). CONCLUSIONS In ESRD-HD patients with aortic stenosis, mortality was lower in the short-term with TAVR compared with SAVR but comparable in the mid-term. AVR is associated with an improvement in survival and reduction in heart failure hospitalizations compared with conservative management.
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Affiliation(s)
- Amgad Mentias
- Division of Cardiovascular Medicine, University of Iowa Carver College of Medicine, Iowa City (A.M., P.A.H., J.D.R., S.P., M.V.-S.)
| | - Milind Y Desai
- Heart and Vascular Institute, Cleveland Clinic Foundation, OH (M.Y.D., S.K.)
| | - Marwan Saad
- Cardiovascular Institute, The Warren Alpert Medical School at Brown University, Providence, RI (M.S.)
| | - Phillip A Horwitz
- Division of Cardiovascular Medicine, University of Iowa Carver College of Medicine, Iowa City (A.M., P.A.H., J.D.R., S.P., M.V.-S.)
| | - James D Rossen
- Division of Cardiovascular Medicine, University of Iowa Carver College of Medicine, Iowa City (A.M., P.A.H., J.D.R., S.P., M.V.-S.)
| | - Sidakpal Panaich
- Division of Cardiovascular Medicine, University of Iowa Carver College of Medicine, Iowa City (A.M., P.A.H., J.D.R., S.P., M.V.-S.)
| | - Hani Jneid
- Division of Cardiology, Baylor College of Medicine, Houston, TX (H.J.)
| | - Samir Kapadia
- Heart and Vascular Institute, Cleveland Clinic Foundation, OH (M.Y.D., S.K.)
| | - Mary Vaughan-Sarrazin
- Division of Cardiovascular Medicine, University of Iowa Carver College of Medicine, Iowa City (A.M., P.A.H., J.D.R., S.P., M.V.-S.).,Comprehensive Access and Delivery Research and Evaluation Center (CADRE), Iowa City VA Medical Center (M.V.-S.)
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Yamauchi T, Yamamoto H, Miyata H, Kobayashi J, Masai T, Motomura N. Surgical Aortic Valve Replacement for Aortic Stenosis in Dialysis Patients ― Analysis of Japan Cardiovascular Surgery Database ―. Circ J 2020; 84:1271-1276. [DOI: 10.1253/circj.cj-20-0042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Takashi Yamauchi
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital
| | - Hiroyuki Yamamoto
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo
| | - Hiroaki Miyata
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo
| | - Junjiro Kobayashi
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Takafumi Masai
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital
| | - Noboru Motomura
- Department of Cardiovascular Surgery, Toho University, Sakura Medical Center
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Mechanical or biological heart valve for dialysis-dependent patients? A meta-analysis. J Thorac Cardiovasc Surg 2020; 163:2057-2071.e12. [PMID: 32778466 DOI: 10.1016/j.jtcvs.2020.05.101] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 05/12/2020] [Accepted: 05/31/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The optimal selection of prosthetic heart valve for dialysis-dependent patients remains controversial. We investigated the comparative effectiveness and safety of mechanical prosthesis (MP) and bioprosthesis (BP) for these patients. METHODS After the systematic review, we included studies that involved patients on dialysis undergoing aortic valve replacement or mitral valve replacement (MVR) and reported comparative outcomes of MP and BP. Meta-analysis was performed using random-effects model. We conducted a subgroup analysis based on the valve position and postoperative international normalized ratio (INR), which was extracted from either tables or methods of each study. A meta-regression was used to examine the effects of study-level covariates. RESULTS We included 24 retrospective studies without randomized-controlled trials, involving 10,164 participants (MP = 6934, BP = 3230). Patients undergoing aortic valve replacement with MP exhibited a better long-term survival effectiveness (hazard ratio, 0.64; 95% confidence interval [CI], 0.47-0.86). Conversely, studies including MVR demonstrated little difference in survival (hazard ratio, 0.90; 95% CI, 0.73-1.12). A meta-regression revealed that age had little effect on long-term survival difference between MP and BP (β = -0.0135, P = .433). MP had a significantly greater bleeding risk than did BP when INR was above 2.5 (incidence rate ratio, 10.58; 95% CI, 2.02-55.41). However, when INR was below 2.5, bleeding events were comparable (incidence rate ratio, 1.73; 95% CI, 0.78-3.82). The structural valve deterioration rate was significantly lower in MP (risk ratio, 0.24; 95% CI, 0.14-0.44). CONCLUSIONS MP is a reasonable choice for dialysis-dependent patients without additional thromboembolic risk requiring aortic valve replacement, for its better long-term survival, durability, and noninferior bleeding risk compared with BP. Conversely, BP might be an appropriate selection for patients with MVR, given its similar survival rate and lower bleeding risk. Although our meta-regression demonstrates little influence of age on long-term survival difference between MP and BP, further studies stratifying patients based on age cut-off are mandatory.
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Nissen AP, Nguyen TC. Commentary: Tissue is the issue-Bioprosthetic versus mechanical valves in dialysis-dependent patients. J Thorac Cardiovasc Surg 2019; 158:59-60. [PMID: 30723022 DOI: 10.1016/j.jtcvs.2018.12.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 12/10/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Alexander P Nissen
- Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center Houston, McGovern Medical School, Houston, Tex
| | - Tom C Nguyen
- Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center Houston, McGovern Medical School, Houston, Tex.
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Yan W, Arora RC, Yamashita MH. Commentary: Does valve choice matter in patients receiving hemodialysis? J Thorac Cardiovasc Surg 2018; 157:2187-2188. [PMID: 30414775 DOI: 10.1016/j.jtcvs.2018.09.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 09/17/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Weiang Yan
- Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Cardiac Sciences Program, St. Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Rakesh C Arora
- Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Cardiac Sciences Program, St. Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Michael H Yamashita
- Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Cardiac Sciences Program, St. Boniface Hospital, Winnipeg, Manitoba, Canada.
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