PMID- 30685160
OWN - NLM
STAT- MEDLINE
DCOM- 20200302
LR  - 20240214
IS  - 1097-685X (Electronic)
IS  - 0022-5223 (Print)
IS  - 0022-5223 (Linking)
VI  - 158
IP  - 3
DP  - 2019 Sep
TI  - A 20-year multicenter analysis of dialysis-dependent patients who had aortic or 
      mitral valve replacement: Implications for valve selection.
PG  - 805-813.e2
LID - S0022-5223(18)33278-1 [pii]
LID - 10.1016/j.jtcvs.2018.10.168 [doi]
AB  - OBJECTIVE: Valve selection in dialysis-dependent patients can be difficult 
      because long-term survival is diminished and bleeding risks during 
      anticoagulation treatment are greater in patients with renal failure. In this 
      study we analyzed long-term outcomes of dialysis-dependent patients who underwent 
      valve replacement to help guide optimal prosthetic valve type selection. METHODS: 
      Dialysis-dependent patients who underwent aortic and/or mitral valve replacement 
      at 3 institutions over 20 years were examined. The primary outcome was long-term 
      survival. A Cox regression model was used to estimate survival according to 5 
      ages, presence of diabetes, and/or heart failure symptoms. RESULTS: Four hundred 
      twenty-three available patients were analyzed; 341 patients had biological and 82 
      had mechanical valves. Overall complication and 30-day mortality rates were 
      similar between the groups. Thirty-day readmission rates for biological and 
      mechanical groups were 15% (50/341) and 28% (23/82; P = .005). Five-year survival 
      was 23% and 33% for the biological and mechanical groups, respectively. After 
      adjusting for age, New York Heart Association (NYHA) class, and diabetes using a 
      multivariable Cox regression model, survival was similar between groups (hazard 
      ratio, 0.93; 95% confidence interval, 0.66-1.29; P = .8). A Cox regression model 
      on the basis of age, diabetes, and heart failure, estimated that patients only 30 
      or 40 years old, with NYHA class I-II failure without diabetes had a >50% 
      estimated 5-year survival (P < .001). CONCLUSIONS: Dialysis-dependent patients 
      who underwent valve replacement surgery had poor long-term survival. Young 
      patients without diabetes or NYHA III or IV symptoms might survive long enough to 
      justify placement of a mechanical valve; however, a biological valve is suitable 
      for most patients.
CI  - Copyright (c) 2018 The American Association for Thoracic Surgery. Published by 
      Elsevier Inc. All rights reserved.
FAU - Manghelli, Joshua L
AU  - Manghelli JL
AD  - Division of Cardiothoracic Surgery, Barnes-Jewish Hospital, Washington University 
      School of Medicine, St Louis, Mo.
FAU - Carter, Daniel I
AU  - Carter DI
AD  - Division of Cardiothoracic Surgery, Barnes-Jewish Hospital, Washington University 
      School of Medicine, St Louis, Mo.
FAU - Khiabani, Ali J
AU  - Khiabani AJ
AD  - Division of Cardiothoracic Surgery, Barnes-Jewish Hospital, Washington University 
      School of Medicine, St Louis, Mo.
FAU - Gauthier, Jason M
AU  - Gauthier JM
AD  - Division of Cardiothoracic Surgery, Barnes-Jewish Hospital, Washington University 
      School of Medicine, St Louis, Mo.
FAU - Moon, Marc R
AU  - Moon MR
AD  - Division of Cardiothoracic Surgery, Barnes-Jewish Hospital, Washington University 
      School of Medicine, St Louis, Mo.
FAU - Munfakh, Nabil A
AU  - Munfakh NA
AD  - Division of Cardiothoracic Surgery, Christian Northeast Hospital, Washington 
      University School of Medicine, St Louis, Mo.
FAU - Damiano, Ralph J
AU  - Damiano RJ
AD  - Division of Cardiothoracic Surgery, Barnes-Jewish Hospital, Washington University 
      School of Medicine, St Louis, Mo.
FAU - Corvera, Joel S
AU  - Corvera JS
AD  - Division of Cardiothoracic Surgery, Indiana University School of Medicine, 
      Methodist Hospital, Indianapolis, Ind.
FAU - Melby, Spencer J
AU  - Melby SJ
AD  - Division of Cardiothoracic Surgery, Barnes-Jewish Hospital, Washington University 
      School of Medicine, St Louis, Mo. Electronic address: smelby@wustl.edu.
LA  - eng
GR  - F32 HL078136/HL/NHLBI NIH HHS/United States
GR  - I01 CX001526/CX/CSRD VA/United States
GR  - T32 HL007776/HL/NHLBI NIH HHS/United States
PT  - Journal Article
PT  - Multicenter Study
PT  - Webcast
DEP - 20181213
PL  - United States
TA  - J Thorac Cardiovasc Surg
JT  - The Journal of thoracic and cardiovascular surgery
JID - 0376343
SB  - IM
CIN - J Thorac Cardiovasc Surg. 2019 Sep;158(3):814-815. PMID: 30470542
CIN - J Thorac Cardiovasc Surg. 2019 Sep;158(3):816-817. PMID: 30527727
CIN - J Thorac Cardiovasc Surg. 2019 Sep;158(3):812-813. PMID: 30685167
MH  - Adult
MH  - Aortic Valve/physiopathology/*surgery
MH  - *Bioprosthesis
MH  - Clinical Decision-Making
MH  - Female
MH  - *Heart Valve Prosthesis
MH  - Heart Valve Prosthesis Implantation/adverse effects/*instrumentation/mortality
MH  - Hemodynamics
MH  - Humans
MH  - Kidney Failure, Chronic/mortality/physiopathology/*therapy
MH  - Male
MH  - Middle Aged
MH  - Mitral Valve/physiopathology/*surgery
MH  - Patient Selection
MH  - Prosthesis Design
MH  - *Renal Dialysis/adverse effects/mortality
MH  - Risk Factors
MH  - Time Factors
MH  - Treatment Outcome
MH  - United States
PMC - PMC6709586
MID - NIHMS1519463
OTO - NOTNLM
OT  - dialysis
OT  - renal failure
OT  - valve replacement
EDAT- 2019/01/28 06:00
MHDA- 2020/03/03 06:00
PMCR- 2020/09/01
CRDT- 2019/01/28 06:00
PHST- 2018/04/30 00:00 [received]
PHST- 2018/10/23 00:00 [revised]
PHST- 2018/10/28 00:00 [accepted]
PHST- 2019/01/28 06:00 [pubmed]
PHST- 2020/03/03 06:00 [medline]
PHST- 2019/01/28 06:00 [entrez]
PHST- 2020/09/01 00:00 [pmc-release]
AID - S0022-5223(18)33278-1 [pii]
AID - 10.1016/j.jtcvs.2018.10.168 [doi]
PST - ppublish
SO  - J Thorac Cardiovasc Surg. 2019 Sep;158(3):805-813.e2. doi: 
      10.1016/j.jtcvs.2018.10.168. Epub 2018 Dec 13.