Misawa Yoshio
Division of Cardiovascular Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan.
Ann Thorac Cardiovasc Surg. 2010 Aug;16(1):4-8.
There is some controversy regarding the choice of prosthetic valves in patients with heart disease and concomitant end-stage renal disease requiring chronic dialysis. Dialysis patients tend to have a short life expectancy. In Japan, the 1-year survival of the dialysis patients was 80% in the 1980s, but exceeds 85% in the 2000s. The 5-year survival has been 54%-60% for the past 20 years. In addition, the 10-year and 15-year survivals have been 35%-42% and 23%-31%, respectively. However, in the United States, the 5-year survival had only improved to 35% among patients who started dialysis between 1996 and 2000, and the life expectancies of chronic dialysis patients in their sixth, seventh and eighth decades is 5.3-6.2 years, 3.8-4.5 years, and 2.7-3.2 years, respectively. The life expectancy of dialysis patients in Japan is thus better than that of patients in the United States. Some surgeons prefer to use bioprosthetic valves because of a high rate of hemorrhagic complications in dialysis patients. They are hesitant to use anticoagulation therapy in dialysis patients with mechanical valves. Others prefer mechanical valves because of the potential for early structural dysfunction of bioprosthetic valves implanted in the dialysis patients with abnormal calcium metabolism, which can cause calcium deposition on the bioprosthetic valves during the early postoperative period. The life expectancy of dialysis patients in Japan is relatively high. The potential risk of early calcification of bioprosthetic valves should be taken into account when choosing prosthetic heart valves for these patients in Japan.
对于患有心脏病且伴有需要长期透析的终末期肾病患者，人工心脏瓣膜的选择存在一些争议。透析患者往往预期寿命较短。在日本，20世纪80年代透析患者的1年生存率为80%，但在21世纪超过了85%。在过去20年中，5年生存率一直为54% - 60%。此外，10年和15年生存率分别为35% - 42%和23% - 31%。然而，在美国，1996年至2000年间开始透析的患者中，5年生存率仅提高到35%，60岁、70岁和80岁慢性透析患者的预期寿命分别为5.3 - 6.2年、3.8 - 4.5年和2.7 - 3.2年。因此，日本透析患者的预期寿命高于美国患者。一些外科医生倾向于使用生物人工瓣膜，因为透析患者出血并发症发生率较高。他们对于在植入机械瓣膜的透析患者中使用抗凝治疗犹豫不决。另一些人则倾向于使用机械瓣膜，因为对于钙代谢异常的透析患者植入生物人工瓣膜存在早期结构功能障碍的可能性，这可能在术后早期导致生物人工瓣膜上的钙沉积。日本透析患者的预期寿命相对较高。在为日本的这些患者选择人工心脏瓣膜时，应考虑生物人工瓣膜早期钙化的潜在风险。
