Surgical aortic valve replacement for aortic stenosis in dialysis patients: Analysis of Japan cardiovascular surgery database

Takashi Yamauchi, Hiroyuki Yamamoto, Hiroaki Miyata, Junjiro Kobayashi, Takafumi Masai, Noboru Motomura

Research output: Contribution to journalArticle

Abstract

Background: Perioperative risk during surgical aortic valve replacement (SAVR) is reportedly high in dialysis patients. We aimed to determine the postoperative mortality and morbidity and identify the perioperative risk factors of mortality during SAVR in dialysis-dependent patients. Methods and Results: From the Japan Adult Cardiovascular Surgery Database, we compared 2,875 dialysis-dependent patients with 18,839 non-dialysis patients who all underwent SAVR between January 2013 and December 2016. The operative mortality was 8.7% vs. 2.0% in the dialysis and non-dialysis groups, respectively. Multivariate stepwise logistic regression analysis for operative mortality revealed 8 independent risk factors including age (odds ratio [OR]=1.2), concomitant coronary artery bypass grafting (OR=1.5), peripheral arterial disease (OR=1.9), atrial fibrillation (OR=2.5), New York Heart Association class IV (OR=2.5), liver dysfunction (OR=5.8), reduced left ventricular function (OR=1.4), and history of previous cardiac surgery (OR=2.1). In addition, 8 postoperative predictors of operative mortality were identified including bleeding deep sternal infection (OR=3.4), prolonged ventilation (OR=5.4) and gastrointestinal complications (OR=10.3). Conclusions: Compared with non-dialysis patients, SAVR in dialysis patients was associated with high rates of mortality and morbidity. An appropriate surgical strategy and careful perioperative assessment and management for prevention of infection, and respiratory and gastrointestinal complications might contribute to improved clinical outcomes after SAVR in these patients.

Original languageEnglish
Pages (from-to)1271-1276
Number of pages6
JournalCirculation Journal
Volume84
Issue number8
DOIs
Publication statusPublished - 2020

Keywords

  • Aortic stenosis
  • Aortic valve replacement
  • Dialysis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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