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Valve replacement in patients with chronic renal failure requiring hemodialysis

What is the best option: mechanical valve or xenograft?

Klappenersatz bei Patienten mit chronischem, dialysepflichtigem Nierenversagen – Was ist die beste Wahl: Mechanische oder biologische Prothese?

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Clinical Research in Cardiology Supplements Aims and scope

Zusammenfassung

Eine beschleunigte Degeneration von biologischen Klappenprothesen bei Dialyse-Patienten im Vergleich zum Normalkollektiv kann in aktuellen Publikationen nicht mehr gezeigt werden. Daher sind biologische Klappenprothesen eine exzellente Alternative für die Gruppe der Dialyse-Patienten, sofern eine Rekonstruktion nicht möglich ist. Bei Patienten mit lebensbedrohlichen Blutungskomplikationen in der Anamnese oder anderen Kontraindikationen für eine Antikoagulation mit Coumarinderivaten sollte biologischen Klappenprothesen auf jeden Fall der Vorzug gegeben werden. Das Paradigma der mechanischen Klappenprothesen in dieser speziellen Patientengruppe muss neu überdacht werden – allerdings ist die Studienlage derzeit noch nicht ausreichend für eine evidenzbasierte Empfehlung.

Summary

Heart valve surgery is associated with a significantly increased risk in patients on chronic hemodialysis. Current literature search indicates that there are not enough data available to allow for an evidence-based selection of prothesis for the individual patient. Mechanical prosthesis require oral anticoagulation, which is regarded as an distinctive disadvantage for patients on chronic hemodialysis. Xenografts may carry an increased risk for structural valve deterioration in the presence of chronic renal failure. Therefore the current guidelines of the ACC recommend (class II recommendation) the use of a mechanical valve prothesis in patients with renal failure, on hemodialysis or with hypercalcemia.

However, based on our own results as well as on recent publications mid term survival is extremely poor in this patient population. Furthermore accelerated xenograft structural valve deterioration has not been observed as compared to the general population receiving heart valve replacement therapy. Therefore xenografts may be an excellent alternative in patients on chronic dialysis requiring heart valve replacement if valve repair is not feasible.

The paradigm of mechanical protheses in this patient group definitely should be reconsidered; however, more data are necessary for an evidence-based decision.

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References

  1. Brinkman WT, Williams WH, Guyton RA, Jones EL, Craver JM (2002) Valve replacement in patients on chronic renal dialysis: implications for valve prosthesis selection. Ann Thorac Surg 74(1):37–42

    Article  PubMed  Google Scholar 

  2. Herzog CA, Ma JZ, Collins AJ (2002) Long-term survival of dialysis patients in the United States with prosthetic heart valves: should ACC/AHA practice guidelines on valve selection be modified? Circulation 105(11):1336–1341

    Article  PubMed  Google Scholar 

  3. Kaplon RJ, Cosgrove DM, III, Gillinov AM, Lytle BW, Blackstone EH, Smedira NG (2000) Cardiac valve replacement in patients on dialysis: influence of prosthesis on survival. Ann Thorac Surg 70(2):438–441

    Article  PubMed  CAS  Google Scholar 

  4. Lucke JC, Samy RN, Atkins BZ, Silvestry SC, Douglas JM Jr, Schwab SJ et al (1997) Results of valve replacement with mechanical and biological prostheses in chronic renal dialysis patients. Ann Thorac Surg 64(1):129–132

    Article  PubMed  CAS  Google Scholar 

  5. Lamberti JJ, Wainer BH, Fisher KA, Karunaratne HB, Al Sadir J (1979) Calcific stenosis of the porcine heterograft. Ann Thorac Surg 28(1):28–32

    Article  PubMed  CAS  Google Scholar 

  6. Monson BK, Wickstrom PH, Haglin JJ, Francis G, Comty CM, Helseth HK (1980) Cardiac operation and endstage renal disease. Ann Thorac Surg 30(3):267–272

    Article  PubMed  CAS  Google Scholar 

  7. Raftery MJ, Koffman G, Cameron JS (1989) Calcific stenosis of a mitral valve xenograft in a patient in chronic renal failure. Br Heart J 62(2):161–162

    PubMed  CAS  Google Scholar 

  8. ACC/AHA guidelines for the management of patients with valvular heart disease (1998) A report of the American College of Cardiology/American Heart Association. Task Force on Practice Guidelines (Committee on Management of Patients with Valvular Heart Disease). J Am Coll Cardiol 32(5):1486–1588

    Article  Google Scholar 

  9. Horst M, Mehlhorn U, Hoerstrup SP, Suedkamp M, de Vivie ER (2000) Cardiac surgery in patients with endstage renal disease: 10-year experience. Ann Thorac Surg 69(1):96–101

    Article  PubMed  CAS  Google Scholar 

  10. Chan V, Jamieson WR, Fleisher AG, Denmark D, Chan F, Germann E (2006) Valve replacement surgery in end-stage renal failure: mechanical prostheses vs bioprostheses. Ann Thorac Surg 81(3):857–862

    Article  PubMed  Google Scholar 

  11. Gummert JF, Kluge M, Heidrich L, Janke R, Autschbach R, Mohr FW (2000) Weiterentwicklung des Medizinischen Dokumentationssystems Medwork TM im Herzzentrum Leipzig: Erfahrungen und Perspektiven. In: Krian A, Scheld HH (eds) Dokumentationsverfahren in der Herzchirurgie V. Steinkopff, Darmstadt, S 89–94

  12. Lansing AM, Leb DE, Berman LB (1968) Cardiovascular surgery in end-stage renal failure. JAMA 204(8):682–686

    Article  PubMed  CAS  Google Scholar 

  13. Rubel JR, Milford EL (2003) The relationship between serum calcium and phosphate levels and cardiac valvular procedures in the hemodialysis population. Am J Kidney Dis 41(2):411–421

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Klinik für Herz- und Thoraxchirurgie, Universitätsklinikum Jena, Erlanger Allee 101, 07747, Jena, Germany

    J. F. Gummert, T. Bossert, T. Walther, M. Barten, N. Doll, V. Falk & F. W. Mohr

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  1. J. F. Gummert
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  2. T. Bossert
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  3. T. Walther
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  4. M. Barten
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  5. N. Doll
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  6. V. Falk
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  7. F. W. Mohr
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Correspondence to J. F. Gummert.

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Gummert, J.F., Bossert, T., Walther, T. et al. Valve replacement in patients with chronic renal failure requiring hemodialysis. Clin Res Cardiol Suppl 2 (Suppl 1), S34–S38 (2007). https://doi.org/10.1007/s11789-006-0035-8

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  • DOI: https://doi.org/10.1007/s11789-006-0035-8

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