Transapical aortic valve implantation in dialysis-dependent patients
Sergey Leontyev, Philip Kiefer, Norman Mangner, Axel Linke, Gerhard Schuler, Friedrich W. Mohr, David Holzhey.
Heart centre Leipzig, Leipzig, Germany.
OBJECTIVE: The treatment of dialysis-dependent patients is associated with increased postoperative morbidity and in-hospital mortality. The purpose of the presented study was to evaluate outcome in those patients who underwent transapical aortic valve implantation (TA AVI) for severe aortic valve stenosis.
METHODS: A total of 47 dialysis-dependent patients underwent TA AVI between 2008 and 2015. The mean age was 75 ± 8 years and 66% were male. The mean STS score and EUROScore logistic II score were 14.5 ± 10.6 (range 30.4 - 2.1) and 8.4 ±6 (range 48.5 - 2.8), respectively. The most common comorbidities were diabetes (38.3%), COPD (39.1%), peripheral vascular disease (40.4%), pulmonary hypertension (36.2%).
RESULTS: In-hospital mortality was 25.5% (n=12) for all patients. Sternotomy and conventional aortic valve replacement was necessary in one patient (2.1 %) because of annulus rupture. The most common reasons for death were sepsis, heart insufficiency and multi organ failure. Other postoperative complications were pneumonia (15.2 %), low cardiac output (10.9%), bleeding (6.5%), AV Block with pacemaker implantation (17.4%), stroke (6.3 %) and sepsis (8.7 %). Wound healing complication was observed in one patient (2.2 %). One year survival was 44±1% with estimated mean survival time 2.5±0.5 years.
CONCLUSIONS: Transapical aortic valve implantation in dialysis-dependent patients was associated with low rate of intraoperative complication. However the early and mid-term mortality were significantly increased because of high risk profile of the patient. The most common postoperative complications were pneumonia and low cardiac output.
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