Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Ann Thorac Surg. 2010 Jan;89(1):65-70. doi: 10.1016/j.athoracsur.2009.10.026.
Few data are available on the outcomes of aortic valve replacement (AVR) in dialysis patients. Valve selection has been controversial, and systemic calcification in these patients has been an important concern. This study reports our experiences and evaluates whether dialysis patients can be treated in a way that is similar to nondialysis patients.
A retrospective review was performed on 73 AVRs (43 men, 29 women), including one redo operation, for dialysis patients between 1995 and 2007. Mean age was 65.0 +/- 8.3 years. The bioprosthesis was basically selected for elderly patients as for nondialysis patients.
For a severely calcified ascending aorta, the femoral or subclavian artery was selected for arterial cannulation in 9 patients (12.3%), and aortic cross-clamping under temporary circulatory arrest with moderate hypothermia was applied in 17 (23.3%). Implanted were 51 mechanical and 22 bioprosthetic valves. Four elderly patients in poor general condition received high-performance mechanical valves instead of bioprosthesis to avoid aortic root enlargement. There was no stroke during the perioperative period. Hospital mortality was 6.8%. The overall actuarial survival rate was 74.6% +/- 5.6%, 55.7% +/- 7.6%, and 39.9% +/- 9.7% at 3, 5, and 10 years, respectively.
The results for the dialysis patients after AVR were satisfactory. Dialysis patients can be treated in AVR just like nondialysis patients. Valve selection and surgical strategy on a case-by-case basis are important to improve the clinical outcomes in dialysis patients.
有关透析患者行主动脉瓣置换术（AVR）的结局数据较少。瓣膜选择存在争议，这些患者的全身钙化一直是一个重要关注点。本研究报告了我们的经验，并评估了是否可以采用类似于非透析患者的方法治疗透析患者。
回顾性分析了 1995 年至 2007 年期间 73 例行 AVR（43 例男性，29 例女性）的透析患者（1 例再次手术）。平均年龄为 65.0±8.3 岁。与非透析患者一样，高龄患者基本选择生物瓣。
对于严重钙化的升主动脉，9 例患者（12.3%）选择股动脉或锁骨下动脉进行动脉插管，17 例患者（23.3%）采用中度低温下临时循环停止的主动脉阻断。植入 51 个机械瓣和 22 个生物瓣。4 例一般情况较差的老年患者因避免主动脉根部扩大而接受高性能机械瓣而非生物瓣。围手术期无卒中发生。住院死亡率为 6.8%。总体存活率为 74.6%±5.6%、55.7%±7.6%和 39.9%±9.7%，分别在 3、5 和 10 年时。
AVR 后透析患者的结果令人满意。可以像非透析患者一样对透析患者进行 AVR 治疗。瓣膜选择和基于具体情况的手术策略对改善透析患者的临床结局非常重要。
