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Surgical Results of Valvular Disease in Hemodialysis Patients
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（Department of Cardiovascular Surgery, Kurume University, Kurume, Japan）
| Hiroyuki Saisho |
Koichi Arinaga |
Takahiro Shojima |
| Yuichiro Hirata |
Takanori Kono |
Koji Akasu |
| Tomokazu Kosuga |
Hiroshi Tomoeda |
Hidetoshi Akashi |
| Hiroyuki Tanaka |
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Background:The Japanese Society for Dialysis Therapy in 2011 reports that the number of
hemodialysis patients has been increasing and that there is an increase in long-term hemodialysis
patients and the aging of hemodialysis induction. Therefore, it can be expected that the number of valve
surgeries in chronic hemodialysis patients will increase. However, there are many problems between
chronic hemodialysis and valve surgery. Objectives:To describe the results of valve surgery in chronic
hemodialysis patients at our institution and evaluate the selection of prosthetic valve and associated
problems. Methods:Between January 2001 and June 2011, a total of 29 patients on chronic
hemodialysis including 3 patients for re-operation, underwent valve replacements. The average age was
67.3±9.3 years and 17（65%）were men. The average dialysis duration was 7.9±6.4 years. The
etiologies of renal failure were 8 for chronic glomerulonephritis（31%), 8 for nephrosclerosis（31%）
and 3 for diabetic nephropathy（12%). Results:There were 2（7.7%）in-hospital deaths, which resulted
from ischemia of intestine and multiple organ failure due to heart failure. Twelve（46%）patients died
during the follow-up period and the 5-year survival rate after surgery was as poor as another authors
have reported previously（30.6%). However, the 5-year survival rate after hemodialysis introduction was
87.1%, which was better than the report of the Japanese Society for Dialysis Therapy in 2011（60%).
Average age was significantly higher in bioprosthetic valves than in mechanical valves（p＝0.02). There
was no significant difference in survival rate among mechanical and bioprosthetic valves（p＝0.75).
There was no significant difference in valve-related complication free rate among mechanical（27.5%）
and bioprosthetic valves（23.4%）（p＝0.9). Three patients with mechanical valves had cerebral
hemorrhage, and 1 patient with bioprosthetic valve had structural valve deterioration. Conclusions:
Surgical result of valvular disease in hemodialysis patients was as poor as another authors reported
previously（5-year survival rate:30.6%), but survival rate after hemodialysis introduction was not very
poor（87.1%). There was no significant difference in survival rate among mechanical and bioprosthetic
valves. Bioprosthetic valve has the risk of reoperation due to early structural valve deterioration, but
there was no significant difference in valve-related complication free rates. Therefore, we should select
prosthetic valve in consideration of individual cases.
Jpn. J. Cardiovasc. Surg. 42:371-376（2013）
Keywords：valvular disease, hemodialysis, prosthetic valve
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