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.

背景：据报道，透析患者的手术主动脉瓣置换术（SAVR）围手术期风险很高。我们旨在确定依赖透析的患者在SAVR期间的术后死亡率和发病率，并确定围手术期死亡的危险因素。

方法和结果：从日本成人心血管外科数据库中，我们比较了2013年1月至2016年12月之间接受SAVR的2875名依赖透析的患者和18839名非透析患者。手术死亡率为8.7％，而透析和非透析组为2.0％ ， 分别。手术死亡率的多变量逐步logistic回归分析显示了8个独立的危险因素，包括年龄（几率[OR] = 1.2），伴随的冠状动脉搭桥术（OR = 1.5），周围动脉疾病（OR = 1.9），心房颤动（OR = 2.5），纽约心脏协会IV级（OR = 2.5），肝功能不全（OR = 5.8），左心室功能降低（OR = 1.4）和先前的心脏手术史（OR = 2.1）。此外，还确定了8种术后死亡率的预测指标，包括深部胸骨感染出血（OR = 3）。

结论：与非透析患者相比，透析患者的SAVR与高死亡率和高发病率有关。适当的手术策略以及仔细的围手术期评估和管理以预防感染以及呼吸道和胃肠道并发症可能有助于改善这些患者的SAVR临床疗效。