Objectives

The number of hemodialysis patients requiring aortic valve replacement (AVR) is increasing. Although bioprosthetic valves are increasingly popular, they are associated with a risk of structural valve deterioration (SVD). The aim of this study is to examine the outcomes of bioprosthetic valves in hemodialysis patients undergoing AVR and to identify treatment strategies that can decrease the risk of SVD.

Methods

Between February 2010 and November 2019, 61 patients on hemodialysis underwent AVR using bioprosthetic valves at our hospital. Five patients died while still in the hospital. Kaplan–Meier estimates of overall survival and univariate Cox proportional hazards regression analyses were performed for the remaining 56 patients.

Results

During follow-up, there were six SVD events (10.7%) related to the bioprosthetic valves. The survival rate was 67.9% at 3 years and 39.5% at 5 years. In all SVD cases, SVD was caused by aortic stenosis. The mean interval between AVR and the discovery of SVD was 41.5 months. The SVD-free rate was 88.6% at 3 years and 65.3% at 5 years. Preoperative phosphorus levels are associated with SVD risk. High preoperative phosphorus concentration is associated with elevated SVD risk.

Conclusions

In this study, we determined that the risk of SVD can be influenced by preoperative phosphorus level. Strict control of the phosphorus concentration of hemodialysis patients may decrease structural valve deterioration after aortic valve replacement.

中文翻译：

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严格控制血透患者磷浓度可减少主动脉瓣置换术后瓣膜结构恶化

目标

需要主动脉瓣置换术 (AVR) 的血液透析患者数量正在增加。尽管生物瓣膜越来越受欢迎，但它们存在结构性瓣膜退化 (SVD) 的风险。本研究的目的是检查生物瓣在接受 AVR 的血液透析患者中​​的结果，并确定可以降低 SVD 风险的治疗策略。

方法

2010 年 2 月至 2019 年 11 月，61 名血液透析患者在我院接受了使用生物瓣膜的 AVR。五名患者在住院期间死亡。对其余 56 名患者进行了总体生存期的 Kaplan-Meier 估计和单变量 Cox 比例风险回归分析。

结果

在随访期间，有 6 起 SVD 事件（10.7%）与生物瓣膜有关。3年生存率为67.9%，5年生存率为39.5%。在所有 SVD 病例中，SVD 是由主动脉瓣狭窄引起的。AVR 与发现 SVD 之间的平均间隔为 41.5 个月。3 年时无 SVD 率为 88.6%，5 年时为 65.3%。术前磷水平与 SVD 风险相关。术前高磷浓度与 SVD 风险升高有关。

结论

在这项研究中，我们确定 SVD 的风险会受到术前磷水平的影响。严格控制血液透析患者的磷浓度可减少主动脉瓣置换术后瓣膜结构的恶化。