Cardiac valve surgery in patients with end-stage renal disease

Patients with ena-stage renal disease are at increased risk for complicatio ns such as endocarditis or accelerated calcification involving their native valve. In a retrospective study we looked at the perioperative risk for le thality and long-term results in valve replacement in patients on chronic d ialysis therapy. Between 1979 and 1994, 40 patients with end-stage renal di sease (mean age 56 +/- 11 years; mean time on dialysis 60 +/- 54 months) un derwent aortic (n = 22), mitral (n = 12) or aortic-/mitral (n = 6) valve re placement at our institution. Combined procedures were valve replacement an d coronary artery bypass grafting in 6 cases. There were 11 (27.5%) emergen cy valve replacements. In most of the patients (80%) mechanical valves were used. The overall 30-day-mortality was 22.5% (14% in elective cases). The overall estimated Kaplan-Meier survival was 62% at 12 months (72% in electi ve cases), 35% at 36 months (44% in elective cases) and 30% at 60 months (3 6% in elective cases). The perioperative deaths (n = 9) were exclusively du e to sepsis. Our results were comparable to the results of other groups who reported on a perioperative mortality between 16% and 36% and a 12-month s urvival of 57 - 70%. The high incidence of emergency valve replacement (29 - 45%) in patients with end-stage renal disease was observed in the other g roups as well. In summary, valve replacement in dialysis patients is associ ated with high perioperative and long-term mortality. It may be expected th at more active prevention and early detection of valve disease might improv e these results. The management of these patients challenges the cooperatio n of nephrologists, cardiologists, anesthesiologists and cardiac surgeons.