1
|
Maeda K, Kuratani T, Mizote I, Hayashida K, Tsuruta H, Takahashi T, Fukuda K, Shimizu H, Sakata Y, Sawa Y. One-year outcomes of the pivotal clinical trial of a balloon-expandable transcatheter aortic valve implantation in Japanese dialysis patients. J Cardiol 2021; 78:533-541. [PMID: 34348863 DOI: 10.1016/j.jjcc.2021.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/23/2021] [Accepted: 07/11/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Dialysis patients with aortic stenosis are generally considered as being at extreme or high surgical risk. Herein, the first clinical trial was conducted to investigate clinical safety and effectiveness of transcatheter aortic valve replacement (TAVR) using the balloon-expandable transcatheter aortic valve (SAPIEN 3, Edwards Lifesciences, Irvine, CA, USA) in Japanese dialysis patients. METHODS The clinical trial is a single arm, prospective, open, non-randomized, Japanese multicenter study. The primary purpose of this trial is to evaluate the efficacy and safety of TAVR using SAPIEN 3 in 28 Japanese dialysis patients. RESULTS Mean age was 79.2 years and 67.9% were male (Mean STS score was 14.3%). Transfemoral and transapical approaches were performed in 25 (89.3%) and 3 patients (10.7%), respectively. All bioprostheses were successfully implanted. Median intensive care unit stay and hospital stay after TAVR were 1.4 days and 6.3 days, respectively. In-hospital mortality was 3.6% and freedom from all-cause mortality at 1 year was 89.3%. Disabling stroke and life-threatening bleeding at 1 year was 7.7% and 8.5%, respectively. There was no structural valve deterioration during follow-up. New York Heart Association functional status, six-minute walk test, and EuroQOL visual analogue scale score significantly improved through 1 year compared with baseline. CONCLUSIONS TAVR using SAPIEN 3 is safe and effective for the treatment of Japanese dialysis patients with symptomatic severe aortic valve stenosis.
Collapse
Affiliation(s)
- Koichi Maeda
- Osaka University Graduate School of Medicine, Yamadaoka 2-2 Suita, Osaka 5650871, Japan
| | - Toru Kuratani
- Osaka University Graduate School of Medicine, Yamadaoka 2-2 Suita, Osaka 5650871, Japan
| | - Isamu Mizote
- Osaka University Graduate School of Medicine, Yamadaoka 2-2 Suita, Osaka 5650871, Japan
| | | | | | | | | | | | - Yasushi Sakata
- Osaka University Graduate School of Medicine, Yamadaoka 2-2 Suita, Osaka 5650871, Japan
| | - Yoshiki Sawa
- Osaka University Graduate School of Medicine, Yamadaoka 2-2 Suita, Osaka 5650871, Japan.
| |
Collapse
|
2
|
Yamaoka H, Yamamoto T, Endo D, Shimada A, Matsushita S, Asai T, Amano A. Rapid decline in cardiac function in diabetic patients with calcified coronary artery disease undergoing hemodialysis: two case reports. BMC Cardiovasc Disord 2021; 21:271. [PMID: 34082711 PMCID: PMC8173516 DOI: 10.1186/s12872-021-02076-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 05/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical symptoms of patients on dialysis do not match the signs of coronary disease progression, making the prediction of the true progression of their medical condition in clinical settings difficult. Emergency and concomitant surgeries are significant risk factors of mortality following open-heart surgery in patients on hemodialysis. CASE PRESENTATION We report two cases of successful coronary artery bypass grafting (CABG) in patients on dialysis with a history of cardiac surgery. The first case describes a 65-year-old woman who had undergone aortic valve replacement 2 years ago and was hospitalized urgently, because of a sudden decline in heart function and hypotension. She had moderate mitral regurgitation with right ventricular pressure of 66 mmHg and poor left ventricular function [left ventricular ejection fraction (LVEF), 40%]. Cineangiography revealed an increase in the rate of stenosis in the left main trunk, from 25 to 99% at admission, in addition to 100% occlusion in proximal left anterior descending artery (LAD) and 99% stenosis in the proximal left circumflex artery (LCX). We inserted an intra-aortic balloon pump preoperatively and performed emergency surgery (Euro II risk score, 61.7%; Society of Thoracic Surgeons (STS) risk score, 56.3%). The second case described a 78-year-old man who had undergone surgery for left atrial myxoma 4 years ago and was hospitalized urgently due to dyspnea, chest discomfort, and an LVEF of 44% (Euro II risk score, 40.7%; STS risk score, 33.2%). Cineangiography revealed an increase in the rate of stenosis in the proximal LAD, from 25% (4 years ago) to 90% at admission, in addition to 99% stenosis in proximal LCX and 95% stenosis in the posterolateral branch of LCX. Both patients underwent emergency CABG due to unstable hemodynamics and decreased left ventricular function despite regular dialysis. The surgeries were successful, and the patients were discharged without any complications. CONCLUSIONS In patients with multiple comorbidities and those who undergo dialysis treatment, calcified lesions in coronary arteries can progress severely and rapidly without any symptoms, including chest pain. Close outpatient management involving nephrologists and the cardiovascular team is necessary for patients on dialysis.
Collapse
Affiliation(s)
- Hironobu Yamaoka
- Department of Cardiovascular surgery, Edogawa Hospital, Higashi Koiwa 2-24-18, Edogawa-ku, Tokyo, 133-0052, Japan
| | - Taira Yamamoto
- Department of Cardiovascular Surgery, Juntendo University, 2-1-1, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Daisuke Endo
- Department of Cardiovascular Surgery, Juntendo University, 2-1-1, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Akie Shimada
- Department of Cardiovascular Surgery, Juntendo University, 2-1-1, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Satoshi Matsushita
- Department of Cardiovascular Surgery, Juntendo University, 2-1-1, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Tohru Asai
- Department of Cardiovascular Surgery, Juntendo University, 2-1-1, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Atsushi Amano
- Department of Cardiovascular Surgery, Juntendo University, 2-1-1, Bunkyo-ku, Tokyo, 113-8421, Japan
| |
Collapse
|
3
|
Bäck C, Hornum M, Møller CJH, Olsen PS. Cardiac surgery in patients with end-stage renal disease on dialysis. SCAND CARDIOVASC J 2017; 51:334-338. [PMID: 28978256 DOI: 10.1080/14017431.2017.1384565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Over the past decade, the number of patients on dialysis and with cardiovascular diseases has steadily increased. This retrospective analysis compares the postoperative mortality after cardiac surgery between patients on hemodialysis and peritoneal dialysis. METHODS Between 1998 and 2015, 136 patients with end-stage renal disease initiating dialysis more than one month before surgery underwent cardiac surgery. Demographics, preoperative hemodynamic and biochemical data were collected from the patient records. Vital status and date of death was retrieved from a national register. RESULTS Hemodialysis was undertaken in 73% and peritoneal dialysis in 22% of patients aged 59.7 ± 12.9 years, mean EuroSCORE 8.6% ± 3.5. Isolated coronary artery bypass graft was performed in 46%, isolated valve procedure in 29% and combined procedures in 24% with no significant statistical difference between groups. The 30-day mortality was 14% for hemodialysis patients and 3% for peritoneal dialysis patients (p = .056). One-year and 5-year mortality were, 30% and 59% in the hemodialysis group, 30% and 57% in the peritoneal dialysis group (p = .975, p = .852). Independent predictors of total mortality were age (p = .001), diabetes (p = .017) and active endocarditis (p = .012). CONCLUSION No statistically significant difference in mortality was found between patients in hemo- or peritoneal dialysis. However, we observed that patients with end-stage renal disease on dialysis have two times higher mortality rate than estimated by EuroSCORE.
Collapse
Affiliation(s)
- Caroline Bäck
- a Department of Cardiothoracic Surgery RT , Heartcenter, Rigshospitalet, Copenhagen University Hospital , Copenhagen , Denmark
| | - Mads Hornum
- b Department of Nephrology , Abdominal Center, Rigshospitalet, Copenhagen University Hospital , Copenhagen , Denmark
| | - Christian Joost Holdflod Møller
- a Department of Cardiothoracic Surgery RT , Heartcenter, Rigshospitalet, Copenhagen University Hospital , Copenhagen , Denmark
| | - Peter Skov Olsen
- a Department of Cardiothoracic Surgery RT , Heartcenter, Rigshospitalet, Copenhagen University Hospital , Copenhagen , Denmark
| |
Collapse
|
4
|
Hibino M, Oshima H, Narita Y, Abe T, Mutsuga M, Fujimoto KL, Tokuda Y, Terazawa S, Ito H, Usui A. Early and Late Outcomes of Thoracic Aortic Surgery in Hemodialysis Patients. Ann Thorac Surg 2016; 102:1282-8. [DOI: 10.1016/j.athoracsur.2016.03.073] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 03/18/2016] [Accepted: 03/22/2016] [Indexed: 11/16/2022]
|
5
|
Fernando M, Paterson HS, Byth K, Robinson BM, Wolfenden H, Gracey D, Harris D. Outcomes of cardiac surgery in chronic kidney disease. J Thorac Cardiovasc Surg 2014; 148:2167-73. [DOI: 10.1016/j.jtcvs.2013.12.064] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 11/24/2013] [Accepted: 12/10/2013] [Indexed: 11/25/2022]
|
6
|
Sezai A, Nakata KI, Hata M, Yoshitake I, Wakui S, Hata H, Shiono M. Long-Term Results of Dialysis Patients with Chronic Kidney Disease Undergoing Coronary Artery Bypass Grafting. Ann Thorac Cardiovasc Surg 2013; 19:441-8. [DOI: 10.5761/atcs.oa.12.02028] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
7
|
Thourani VH, Sarin EL, Kilgo PD, Lattouf OM, Puskas JD, Chen EP, Guyton RA. Short- and long-term outcomes in patients undergoing valve surgery with end-stage renal failure receiving chronic hemodialysis. J Thorac Cardiovasc Surg 2012; 144:117-23. [DOI: 10.1016/j.jtcvs.2011.07.057] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Revised: 07/04/2011] [Accepted: 07/26/2011] [Indexed: 10/17/2022]
|
8
|
Fukui S, Yamamura M, Mitsuno M, Tanaka H, Ryomoto M, Miyamoto Y. Aortic valve prosthesis selection in dialysis patients based on the patient's condition. J Artif Organs 2012; 15:162-7. [PMID: 22367052 DOI: 10.1007/s10047-012-0631-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Accepted: 02/01/2012] [Indexed: 11/28/2022]
Abstract
Previous studies have examined outcomes in dialysis patients undergoing cardiac surgery. However, only a few studies have solely focused on outcomes after aortic valve replacement (AVR). This study aimed to clarify independent predictors of the long-term survival of dialysis patients with AVR and to determine whether a mechanical valve or bioprosthesis is suitable based on the patient's condition. A total of 38 consecutive dialysis patients who underwent AVR at our institute were reviewed (mean age 69.1 ± 9.4 years). There were 23 bioprostheses and 15 mechanical valve replacements. The operative mortality and the long-term survival were not different between the bioprosthesis and the mechanical valve group (13.0 vs. 13.3%). The significant multivariate predictors for long-term survival were concomitant coronary artery bypass grafting (CABG) and prosthesis size. Valve types and age at operation did not affect long-term survival. Five-year survival of patients with small prosthetic valves and concomitant CABG was 0%. When the patient's quality of life is taken into account, it may be appropriate to use a bioprosthesis in a dialysis patient with a small annulus and concomitant CABG even if the patient is young.
Collapse
Affiliation(s)
- Shinya Fukui
- Department of Cardiovascular Surgery, Hyogo College of Medicine, 1-1 Mukogawa-chou, Nishinomiya, Hyogo, 663-8501, Japan.
| | | | | | | | | | | |
Collapse
|
9
|
Long-Term Survival for Patients With Preoperative Renal Failure Undergoing Bioprosthetic or Mechanical Valve Replacement. Ann Thorac Surg 2011; 91:1127-34. [PMID: 21353200 DOI: 10.1016/j.athoracsur.2010.12.056] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Revised: 12/24/2010] [Accepted: 12/30/2010] [Indexed: 11/22/2022]
|
10
|
Yamamura M, Mitsuno M, Tanaka H, Ryomoto M, Fukui S, Yoshioka Y, Kajiyama T, Miyamoto Y. Early Application of Continuous Hemodiafiltration (CHDF) after Open Heart Surgery on Hemodialysis Patients. ACTA ACUST UNITED AC 2010. [DOI: 10.4326/jjcvs.39.300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|