Skip to main content

Advertisement

SpringerLink
Log in

Strict control of phosphorus concentration of hemodialysis patients may decrease structural valve deterioration after aortic valve replacement

  • Original Article
  • Published:
General Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Akins CW, Miller DC, Turina MI, Kouchoukos NT, Blackstone EH, Grunkemeier GL, et al. Guidelines for reporting mortality and morbidity after cardiac valve interventions. Ann Thorac Surg. 2008;85:1490–5.

    Article  Google Scholar 

  2. Capodanno D, Petronio AS, Prendergast B, Eltchaninoff H, Vahanian A, Modine T, et al. Standardized definitions of structural deterioration and valve failure in assessing long-term durability of transcatheter and surgical aortic bioprosthetic valves: a consensus statement from the EAPCI endorsed by the ESC and the EACTS. Eur Heart J. 2017;38:3382–90.

    Article  Google Scholar 

  3. Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant. 2013;48:452–8.

    Article  CAS  Google Scholar 

  4. VARC-3 WRITING COMMITTEE, Philippe G, Nicolo P, Maria CA, Tamim N, Rebecca TH, Philippe P, et al. Valve academic research consortium 3: updated endpoint definitions for aortic valve clinical research. Ther Apher Dial. 2021;77:2717–46.

    Google Scholar 

  5. Masakane I, Nakai S, Ogata S, Kimata N, Hanafusa N, Hamano T, et al. An overview of regular dialysis treatment in Japan (as of 31 December 2013). Ther Apher Dial. 2015;19:540–74.

    Article  CAS  Google Scholar 

  6. Ohara T, Hashimoto Y, Matsumura A, Suzuki M, Isobe M. Accelerated progression and morbidity in patients with aortic stenosis on chronic dialysis. Circ J. 2005;69:1535–9.

    Article  Google Scholar 

  7. Aljohani S, Alqahtani F, Almustafa A, Boobes K, Modi S, Alkhouli M. Trends and outcomes of aortic valve replacement in patients with end-stage renal disease on hemodialysis. Am J Cardiol. 2017;120:1626–32.

    Article  Google Scholar 

  8. Nakatsu T, Minakata K, Tanaka S, Minatoya K. Intermediate-term outcomes of aortic valve replacement with bioprosthetic or mechanical valves in patients on hemodialysis. J Thorac Cardiovasc Surg. 2019;157:2177–86.

    Article  Google Scholar 

  9. Okada N, Tajima K, Takami Y, Kato W, Fujii K, Hibino M, et al. Valve selection for the aortic position in dialysis patients. Ann Thorac Surg. 2015;99:1524–31.

    Article  Google Scholar 

  10. Anselmi A, Flecher E, Chabanne C, Ruggieri VG, Langanay T, Corbineau H, et al. Long-term follow-up of bioprosthetic aortic valve replacement in patients aged ≤60 years. J Thorac Cardiovasc Surg. 2017;154:1534–41.

    Article  Google Scholar 

  11. Chan PG, Sultan I, Gleason TG, Navid F, Kilic A. Mechanical versus bioprosthetic valves in patients on dialysis. J Thorac Dis. 2019;11(5):1996–2005.

    Article  Google Scholar 

  12. Linefsky JP, O’Brien KD, Katz R, Boer LH, Barasch E, Jenny NS, et al. Association of serum phosphate levels with aortic valve sclerosis and annular calcification: the cardiovascular health study. J Am Coll Cardiol. 2011;58:291–7.

    Article  Google Scholar 

  13. Fukagawa M, Yokoyama K, Koiwa F, Taniguchi M, Shoji T, Kazama JJ, et al. Clinical practice guideline for the management of chronic kidney disease—Mineral and bone disorder. Ther Apher Dial. 2013;17:247–88.

    Article  Google Scholar 

Download references

Acknowledgements

The authors would like to thank Chris Rowthorn (http://www.eibunkousei.net/) for English language proofreading.

Author information

Authors and Affiliations

  1. Department of Cardiovascular Surgery, Hiroshima University, Kasumi 1-2-3, Minamiku, Hiroshima, Hiroshima, Japan

    Seimei Go & Shinya Takahashi

  2. Department of Cardiovascular Surgery, Akane-Foundation Tsuchiya General Hospital, Hiroshima, Japan

    Tomokuni Furukawa, Kazunori Yamada, Shingo Mochizuki & Toshifumi Hiraoka

Authors
  1. Seimei Go
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tomokuni Furukawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kazunori Yamada
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shingo Mochizuki
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Toshifumi Hiraoka
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Shinya Takahashi
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Seimei GO: Conceptualization; Data curation; Formal analysis; Writing-original draft. Tomokuni FURUKAWA: Data curation; Writing-review & editing. Kazunori YAMADA: Data curation. Shingo MOCHIZUKI: Data curation. Shinya TAKAHASHI: Supervision, Writing-review & editing.

Corresponding author

Correspondence to Seimei Go.

Ethics declarations

Conflict of interest

There are no undeclared conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Go, S., Furukawa, T., Yamada, K. et al. Strict control of phosphorus concentration of hemodialysis patients may decrease structural valve deterioration after aortic valve replacement. Gen Thorac Cardiovasc Surg 70, 547–552 (2022). https://doi.org/10.1007/s11748-021-01739-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11748-021-01739-6

Keywords

Search

Navigation