Original article: cardiovascularCardiac valve replacement in patients on dialysis: influence of prosthesis on survival
Section snippets
Material and methods
Using the prospective Cardiovascular Information Registry, we identified 8,185 patients undergoing aortic or mitral valve replacement at The Cleveland Clinic Foundation from 1986 to 1997. Of these, 42 patients had end-stage renal disease on chronic preoperative dialysis. No patients were excluded.
The etiologies of renal failure were hypertension (n = 6), diabetes mellitus (n = 8), polycystic disease (n = 5), and interstitial nephritis (n = 10). In 13 patients the etiology of renal failure was
Results
There were no operative deaths. The 3-year survival for patients receiving bioprostheses was 36% (CI, 16% to 56%) and for those receiving mechanical valves it was 50% (CI, 25% to 75%). At 5 years, survival was 27% (CI, 5% to 49%) and 33% (CI, 2% to 65%), respectively (p = 0.3) (Fig 1).
One patient with a mechanical valve required reoperation for prosthetic valve endocarditis (PVE), requiring both aortic (allograft) and mitral (bioprosthesis) valve replacement. However, 4 patients with
Comment
The first report of valve replacement in patients with end-stage renal failure was by Lansing and coworkers in 1968 [5]. In their series, 1 patient with aortic valve endocarditis and another patient with rheumatic mitral regurgitation received Starr-Edwards prostheses (Baxter, Irvine, CA). Both patients underwent successful operations and were discharged from the hospital.
Since that time, there have been many reports of successful valvular operations in patients on dialysis. However, only 2
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