Etiology of renal failure influences the outcome of heart valve replacement in chronic dialysis patients

Abstract

Life expectancy of the chronic dialysis patients depends upon the underlying renal disease, but its influence on the outcome of heart valve replacement has not been studied. We aimed to elucidate the difference in the early and midterm results of heart valve replacement according to the etiology of renal diseases. We retrospectively analyzed 17 patients on chronic dialysis who underwent heart valve replacement from 2002 to October 2009. Underlying renal disease was primary in ten patients (glomerulonephritis 8, others 2) and secondary in seven (nephrosclerosis 4, diabetic nephropathy 3). Mean age was 61 ± 10 for primary and 67 ± 7 for secondary renal diseases. Mean duration of dialysis was 18 ± 6 years for primary and 9 ± 9 for secondary renal diseases (p = 0.02). In the aortic position, mechanical valves were used in 12 patients and bioprostheses in three. In the mitral position, mechanical valves were used in all four. Deep hypothermic operation was required for severe aortic calcification in five (primary 5). Mean follow up period was 23 ± 18 months. There were two in-hospital deaths in patients with primary renal disease. Three-year survival rate including hospital deaths, on the other hand, was higher for primary renal diseases (80%) than secondary ones (34%). Despite elevated perioperative risk due to consequence of longer duration of dialysis, midterm survival of patients with primary renal diseases seemed better than for those with secondary renal diseases. These results may help the choice of heart valve prosthesis in chronic dialysis patients.