Abstract 3405: Short- and Long-Term Outcomes in Patients Undergoing Valve Surgery With End Stage Renal Failure on Chronic Hemodialysis
OBJECTIVE: The objective of this study was to evaluate the impact of chronic preoperative hemodialysis for end-stage renal failure (ESRD) in pts undergoing valve surgery.
METHODS: Retrospective review of pts undergoing primary valve±coronary artery bypass surgery from 1996–2008 at a US academic center was performed. Patients were divided into 2 groups: Group 1 (valve surgery without dialysis, n=5084) and Group 2 (valve surgery with dialysis, n=224). Outcomes were evaluated using multivariable regression analysis (adjusted for 13 pre-operative covariates) and long-term survival was assessed with Kaplan-Meier plots.
RESULTS: Pts in Group 2 were younger (p<0.001); more likely female (p=0.04); and presented with Class 4 NYHA (p<0.001). Ejection fraction was similar between groups (p=0.36). Adjusted perioperative morbidity was similar between groups for stroke (p=0.91) and myocardial infarction (p=0.40). Resource utilization (length of stay) was higher in Group 2 (p<0.001); as was in-hospital mortality (Group 1: 263/5084 (5.2%) vs Group 2: 41/224 (18.3%), p<0.001). 1-, 5-, and 10-year survival was less in Group 2 (Figure⇓, p<0.001); the median survival was 12+ years in Group 1 and 1.6 years in Group 2. Preoperative ESRD, among others, was an independent predictor for short- and long-term mortality.
CONCLUSIONS: In this large cohort of pts, preoperative dialysis confers a high risk of perioperative morbidity and mortality and poor long-term survival rates following valve surgery. Risk stratification and future researcfh efforts should focus on more precise identification of the benefits of valve surgery in this high-risk patient population.