초록접수 현황
| 16F-148 | 구연 발표 |
Valve Replacement Surgery in Severe Chronic Kidney Disease
Min Ho Ju, Sung-Ho Jung, Suk Jung Choo, Cheol Hyun Chung, Jae Won Lee, Joon Bum Kim
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
Background : While the outcomes of valve replacement surgery in patients with severe chronic kidney disease (CKD) are reportedly poor, the impact of prosthetic choices on long-term survival has not been well established in these patients.
Methods : The study involved 131 adult patients (62.4±14.1yrs; 54 females) undergoing heart valve surgery who had stage 4 (n=66) or 5 CKD (end-stage; n=65) based on Kidney Disease Outcomes Quality Initiative Guidelines. To reduce the impact of selection bias between mechanical (n=75) and bio-prostheses groups (n=56), propensity score analyses were conducted.
Results : Patients undergoing bioprosthetic replacement were significantly older and had poorer left ventricular function compared with those undergoing mechanical valve replacement. Early mortality rates were 10.7% in the Bio-group and 8.0% in the Mechanical-group (P=0.82). During a median duration of 39.9 months (Quartile 1-3, 10.8-89.0 months; 94.7% complete), 47 patients died and 9 patients experienced major valve-related complications. After adjustment, there were no significant differences in survival (Hazard ratio [HR], 0.67; 95% confidence interval [CI], 0.42-1.16; P=0.17) and valve-related event-free survival (HR, 0.76; 95% CI, 0.47-1.25; P=0.28) between bio- and mechanical prosthetic replacements.
Conclusion : Outcomes following valve replacement surgery in severe CKD patients were poor with nearly 10% early mortality and overall less than 50% 10-year survival rate. The long-term survival was mainly determined by several baseline risk profiles.Overall the outcomes were comparable between bio- and mechanical prosthetic replacement.
Methods : The study involved 131 adult patients (62.4±14.1yrs; 54 females) undergoing heart valve surgery who had stage 4 (n=66) or 5 CKD (end-stage; n=65) based on Kidney Disease Outcomes Quality Initiative Guidelines. To reduce the impact of selection bias between mechanical (n=75) and bio-prostheses groups (n=56), propensity score analyses were conducted.
Results : Patients undergoing bioprosthetic replacement were significantly older and had poorer left ventricular function compared with those undergoing mechanical valve replacement. Early mortality rates were 10.7% in the Bio-group and 8.0% in the Mechanical-group (P=0.82). During a median duration of 39.9 months (Quartile 1-3, 10.8-89.0 months; 94.7% complete), 47 patients died and 9 patients experienced major valve-related complications. After adjustment, there were no significant differences in survival (Hazard ratio [HR], 0.67; 95% confidence interval [CI], 0.42-1.16; P=0.17) and valve-related event-free survival (HR, 0.76; 95% CI, 0.47-1.25; P=0.28) between bio- and mechanical prosthetic replacements.
Conclusion : Outcomes following valve replacement surgery in severe CKD patients were poor with nearly 10% early mortality and overall less than 50% 10-year survival rate. The long-term survival was mainly determined by several baseline risk profiles.Overall the outcomes were comparable between bio- and mechanical prosthetic replacement.
책임저자: Joon Bum Kim
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
발표자: Min Ho Ju, E-mail : deicidepan@naver,com