Why the study?
Perioperative risk during SAVR is reportedly high in dialysis patients, prompting an evaluation of postoperative mortality, morbidity, and perioperative risk factors in this population.
Does dialysis dependence increase operative mortality and morbidity in patients undergoing surgical aortic valve replacement for aortic stenosis?
Does dialysis dependence increase operative mortality and morbidity in patients undergoing surgical aortic valve replacement for aortic stenosis?
Surgical aortic valve replacement in dialysis patients carries a substantially higher operative mortality (8.7%) compared to non-dialysis patients, highlighting the need for careful perioperative management.
Supports heightened perioperative caution in dialysis patients undergoing SAVR; leaves open optimal mitigation strategies for prospective study.
BACKGROUND: Perioperative risk during surgical aortic valve replacement (SAVR) is reportedly high in dialysis patients. We aimed to determine the postoperative mortality and morbidity and identify the perioperative risk factors of mortality during SAVR in dialysis-dependent patients. METHODS AND RESULTS: From the Japan Adult Cardiovascular Surgery Database, we compared 2,875 dialysis-dependent patients with 18,839 non-dialysis patients who all underwent SAVR between January 2013 and December 2016. The operative mortality was 8.7% vs. 2.0% in the dialysis and non-dialysis groups, respectively. Multivariate stepwise logistic regression analysis for operative mortality revealed 8 independent risk factors including age (odds ratio [OR]=1.2), concomitant coronary artery bypass grafting (OR=1.5), peripheral arterial disease (OR=1.9), atrial fibrillation (OR=2.5), New York Heart Association class IV (OR=2.5), liver dysfunction (OR=5.8), reduced left ventricular function (OR=1.4), and history of previous cardiac surgery (OR=2.1). In addition, 8 postoperative predictors of operative mortality were identified including bleeding deep sternal infection (OR=3.4), prolonged ventilation (OR=5.4) and gastrointestinal complications (OR=10.3). CONCLUSIONS: Compared with non-dialysis patients, SAVR in dialysis patients was associated with high rates of mortality and morbidity. An appropriate surgical strategy and careful perioperative assessment and management for prevention of infection, and respiratory and gastrointestinal complications might contribute to improved clinical outcomes after SAVR in these patients.
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Yamauchi et al. (2020) studied this question.
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