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Heart valve surgery in hemodialysis-dependent patients: nutrition status impact on surgical outcome

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  • Artificial Valve
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Abstract

Valve surgery in hemodialysis-dependent patients is associated with postoperative complications and a high mortality rate, and such patients frequently suffer cachexia. This study aimed to determine pre- and intraoperative risk factors associated with in-hospital mortality and long-term survival in hemodialysis-dependent patients undergoing heart valve surgery from the viewpoint of nutrition status. Eighty-seven hemodialysis-dependent patients who underwent valve surgery between January 1998 and October 2015 were retrospectively reviewed. Thirty-seven potential perioperative risk factors were evaluated. The in-hospital mortality rate was 12.6 % (11 patients). Univariate analysis identified New York Heart Association Functional Classification III or IV, emaciation (body mass index <17.6 kg/m2), total cholesterol <120 mg/dl, serum albumin <3.0 mg/dl, emergent/urgent surgery, and intraoperative blood transfusion >3000 ml as predictors of in-hospital death. Multivariate logistic regression analysis confirmed low serum albumin <3.0 mg/dl (hazard ratio 7.22; p = 0.032) and emergent/urgent operation (hazard ratio 43.57; p = 0.035) as independent predictors of in-hospital death. The 1- and 3-year actuarial survival rates were 64.9 ± 5.4 and 51.8 ± 5.8 %, respectively. Long-term survival estimated by log-rank test was negatively impacted by anemia (hemoglobin <10 mg/dl), low serum albumin, emergent/urgent operation, and infective endocarditis. Multivariate analysis using Cox proportional hazards modeling indicated low serum albumin (hazard ratio 2.12; p = 0.047) and emergent/urgent operation (hazard ratio 8.97; p = 0.0002) as independent predictors of remote death. Hypoalbuminemia and emergent/urgent operation are strong predictors of in-hospital and remote death. Malnutrition before surgery should be considered for operative risk estimation, and adequate preoperative nutrition management may improve surgical outcomes for hemodialysis-dependent patients.

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Authors and Affiliations

  1. Department of Cardiovascular Surgery, Jichi Medical School, Yakushiji 3311-1, Shimotsuke, Tochigi, 329-0498, Japan

    Koji Kawahito, Kei Aizawa, Shinichi Oki, Tsutomu Saito & Yoshio Misawa

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  1. Koji Kawahito
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  2. Kei Aizawa
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  3. Shinichi Oki
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  4. Tsutomu Saito
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  5. Yoshio Misawa
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Correspondence to Koji Kawahito.

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Kawahito, K., Aizawa, K., Oki, S. et al. Heart valve surgery in hemodialysis-dependent patients: nutrition status impact on surgical outcome. J Artif Organs 19, 134–140 (2016). https://doi.org/10.1007/s10047-015-0883-4

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  • DOI: https://doi.org/10.1007/s10047-015-0883-4

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