Cardiac Valve Replacement in Patients with End-Stage Renal Failure: Impact of Prosthesis Type on the Early Postoperative Course[*]

Abstract

Background: It is still unclear whether biological or mechanical valves should be preferred in patients on chronic dialysis therapy. Patients and Methods: We retrospectively analyzed data from 104 patients (66.5 ± 8.6 years) with end-stage renal failure (RF) who underwent aortic or mitral valve replacement between 2002 and 4/2008. Mechanical valves were implanted in 44 (42 %) patients and bioprostheses in 60 (58 %). The two groups were comparable with regard to preoperative data, age and incidence of additional CABG procedures. We studied in-hospital morbidity and mortality, major postoperative complications and length of ICU and hospital stay. Additionally, parameters predicting a poor outcome were analyzed with multivariate regression analysis. Results: The overall hospital mortality was 12.5 % and did not differ between the two groups (mechanical: 13.6 %, biological: 11.7 %, n. s.). In the postoperative course, duration of ventilation and ICU stay were similar, whereas hospital stay was significantly longer for patients with mechanical prostheses (19.5 ± 5.4 vs. 15.6 ± 4.1 days, p < 0.05). Mechanical valve patients had a significantly higher rate of postoperative cerebrovascular incidents (18.2 vs. 8.3 %, p < 0.05) and bleeding complications (15.9 vs. 11.7 %, p < 0.05). Reoperation, obesity, left ventricular ejection fraction < 30 % and previous neurological complications were independent predictors of hospital mortality. Conclusions: Our results demonstrate that in patients with end-stage RF, the use of mechanical valves is associated with a significant risk of complications. Because of the poor overall survival of patients on dialysis, bioprosthesis degeneration will not be a limiting factor. Therefore, preference should be given to biological valves in these patients.

Key words

heart valve surgery - renal failure - mortality - prognostic markers

1 The content of this paper was presented during the 38th annual meeting of the German Society of Thoracic- and Cardiovascular Surgery on February 15–18, 2009 in Stuttgart, Germany.

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1 The content of this paper was presented during the 38th annual meeting of the German Society of Thoracic- and Cardiovascular Surgery on February 15–18, 2009 in Stuttgart, Germany.