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

• Published in: General thoracic and cardiovascular surgery Vol. 70; no. 6; pp. 547 - 552
• Main Authors: Go, Seimei, Furukawa, Tomokuni, Yamada, Kazunori, Mochizuki, Shingo, Hiraoka, Toshifumi, Takahashi, Shinya
• Format: Journal Article
• Language: English
• Published: Singapore Springer Nature Singapore 01.06.2022; Springer Nature B.V
• Subjects: Aortic stenosis; Cardiac Surgery; Cardiology; Cerebrovascular disease; Coronary vessels; Diabetes; Endocarditis; Heart surgery; Hemodialysis; Hospitals; Hypertension; Inflammatory bowel disease; Ischemia; Medicine; Medicine & Public Health; Metabolic disorders; Mortality; Multivariate analysis; Original Article; Patients; Phosphorus; Pneumonia; Prostheses; Respiratory diseases; Sepsis; Surgical Oncology; Thoracic Surgery; Thrombosis; Veins & arteries; Japan; Structural valve deterioration; Control of phosphorus concentration; Aortic valve replacement; Hemodialysis
• ISSN: 1863-6705; 1863-6713
• DOI: 10.1007/s11748-021-01739-6

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.