Abstract 13048: Does Preoperative Chronic Kidney Disease Influence on Durability of Bioprosthetic Valve?
Introduction: Little is known about the influence of preoperative chronic kidney disease (CKD) on survival and durability of bioprosthesis in patients undergoing aortic valve replacement (AVR).
Hypothesis: Preoperative CKD may influence the long-term survival and durability of bioprosthetic valves.
Methods: From January 1986 to December 2001, a total of 574 adult patients underwent AVR with pericardial valves in 9 hospitals. Of those, 499 patients were enrolled in this analysis. CKD was defined as the estimated glomerular filtration rate (eGFR) ≤ 60 ml/min/1.73m2. Also, these patients were stratified according to the eGFR; Level 1: >90, Level 2: 60-90, Level 3: 30-59, Level 4: ≤30. The mean follow-up was 8.2 years with maximum 27 years.
Results: In-hospital mortality was 5.4% in CKD group (n=225, 45%) and 3.8% in non-CKD group (n=274, 55%) (p=0.35). Overall survival at 5, 10, and 15 years were 76%, 48% and 36% in CKD group, whereas 85%, 68% and 43% in non-CKD group (log-rank p≤0.001). As shown in Figure 1a, the advanced CKD level was correlated with higher mortality. On the other hand, during follow-up period, reoperation due to structural valve deterioration (SVD) was necessary in only 2 patients (1.0%) in CKD group and 15 patients (5.8%) in non-CKD group. As shown in Figure 1b, the lower CKD level was rather risk factor for reoperation due to SVD (p≤0.05).
Conclusion: Preoperative CKD and its’ level were significant risk factors for late mortality. However, CKD was not a risk factor for reoperation due to SVD. Because those with poor kidney function preoperatively have limited life expectancy, it is less likely that reoperation become necessary. Thus, bioprosthesis can be chosen regardless of preoperative kidney function.
- © 2013 by American Heart Association, Inc.