We examined the hemodynamic profile of bioprosthetic aortic valves in patients on hemodialysis (HD), longitudinally, and assess the incidence of adverse changes detected by echocardiography. Of 1,146 consecutive patients with severe aortic stenosis who underwent bioprosthetic aortic valve replacement (AVR), 148 patients had end-stage renal disease requiring HD. Each patient on HD was matched one-to-one with a non-HD patient on the basis of propensity scores. The mean follow-up period was 3.3 years for the HD group and 5.9 years for the non-HD group. Follow-up information was available for 95.2%. Postoperative trends of valve hemodynamics derived from linear mixed-effect models showed significant group vs time interactions between the two groups. Stable hemodynamics was consistently observed in the non-HD group, whereas the HD group showed a decrease of -0.06 cm²/y (95% confidence interval (CI), -0.10 to -0.02) in effective orifice area, an increase of 0.8 mm Hg/year (95% CI, 0.4–1.1) in mean pressure gradient, and an increase of 0.08 m/s/year (95%CI, 0.02–0.13) in peak velocity. Cumulative incidence function of SVD more than stage 2 was significantly higher in the HD group (13.1% vs 3.1% at 5 years, Gray test p = 0.01). In a multivariable Fine-Gray analysis, diabetes was independently associated with SVD more than stage 2 in the HD group (subhazard ratio, 1.91; 95% CI, 1.25–2.89; p = 0.02). Survival free-from stenotic-type SVD was significantly lower in HD patients undergoing bioprosthetic AVR. Diabetes was independently associated with postoperative stenotic-type SVD in HD patients.

我们纵向检查了血液透析 (HD) 患者生物主动脉瓣的血流动力学特征，并评估了超声心动图检测到的不良变化的发生率。1,146 名连续的重度主动脉瓣狭窄患者在接受生物人工主动脉瓣置换术 (AVR) 的患者中，148 名患者患有需要 HD 的终末期肾病。根据倾向得分，每位 HD 患者与非 HD 患者一对一匹配。HD 组的平均随访期为 3.3 年，非 HD 组为 5.9 年。95.2% 的随访信息可用。来自线性混合效应模型的瓣膜血流动力学的术后趋势显示两组之间存在显着的组与时间相互作用。在非 HD 组中始终观察到稳定的血流动力学，而 HD 组显示减少 -0.06 cm ²/y（95% 置信区间 (CI)，-0.10 至 -0.02）有效孔面积，平均压力梯度增加 0.8 mm Hg/年（95% CI，0.4–1.1），增加 0.08 m /s/year (95%CI, 0.02–0.13) 峰值速度。HD 组 SVD 超过 2 期的累积发生率函数显着更高（13.1% 对 5 年时的 3.1%，灰色检验 p = 0.01）。在多变量 Fine-Gray 分析中，在 HD 组中，糖尿病与 SVD 的独立相关性高于 2 期（亚风险比，1.91；95% CI，1.25–2.89；p = 0.02）。在接受生物假体 AVR 的 HD 患者中，无狭窄型 SVD 的生存率显着降低。糖尿病与 HD 患者术后狭窄型 SVD 独立相关。