The objective of this study was to assess the long-term outcomes of aortic valve replacement (AVR) for aortic valve stenosis (AS) in patients undertaking chronic renal hemodialysis at the time of the operation. Seventy five hemodialysis patients who underwent AVR between January 1993 and September 2012 were taken into account in this study. Operations included 40 isolated AVR and 35 concomitant AVR and coronary artery bypass grafting (CABG). Other combined AVR (mitral valve operation and aortic root operation) and emergency operations were excluded. Mean patients' age was 66.7 (±8.5) years and 53 out of 75 (70.6%) were male. The etiology of renal failure consisted of diabetic nephropathy (22 cases, 29.3%) and non-diabetic renal failure (53 cases, 70.7%). The mean duration of hemodialysis was 8.1 years. The operative mortality was 6.6%. The 1-year, 3-year, 5 year, and 10-year survival rates were 74.5, 42.1, 29.9, and 6.8%, respectively. Statistical analysis revealed that aortic valve area of less than 0.9 cm² and serum cholinesterase of less than 200 IU/l lead to significant risk for mortality (p<0.05). There was no clear difference between the outcomes of isolated AVR and concomitant AVR and CABG. This study suggests that earlier surgical intervention for AS in hemodialysis patients can improve the long-term outcomes, and serum cholinesterase can be a useful preoperative marker to assess operative results.

There were 3,129 consecutive patients who underwent CABG by only one operator at Kishiwada Tokushukai Hospital between January 1991 and December 2010. These patients included 236 patients requiring chronic renal hemodialysis at the time of operation. They consisted of 181 men and 55 women, with an average age of 64.1±9.7 years. The mean duration of hemodialysis was 10.1±20.4 years. Diabetic nephropathy (133 cases, 56.4%) was the most common disease leading to required for hemodialysis. The operative mortality and the hospital mortality were 3.4% and 6.4% respectively. The 1-year survival rate, the 3-year survival rate, the 5 year survival rate and the 10-year survival rate were 72.4%, 48.3%, 32.4% and 14.3%. Multivariate logistic analysis revealed that only peripheral artery disease (PAD) was a significant risk factor for mortality (p<0.05). The infectious diseases were the most common cause of long term death (24.1%). The mortality rates of CABG in patients with dialysis-dependent renal failure are still higher than those for non-hemodialysis patients. Our data suggest that PAD is a great risk factor for mortality following CABG in hemodialysis patients.

The results of complete graft replacement for thoracoabdominal aortic aneurysm remains unsatisfactory. The operative strategies, including the method of reconstruction of visceral vessels and the protection of abdominal organs and spinal cord, are controversial. Two male patients (53 and 59 years of age) had thoracoabdominal aortic aneurysms including the celiac artery and small abdominal aortic aneurysm in the renal arterial part. They underwent replacement of a large aneurysm using a Dacron prosthesis with reconstruction of the celiac artery. The remaining small aneurysm was wrapped by a bandage of Teflon tape 3mm in width. This wrapping technique was easy to perform and could be sufficiently adapted to the aneurysm preserving visceral arterial branches. The postoperative courses were uneventful. Their postoperative enhanced CTs (41 months and 26 months after surgery, respectively) revealed no enlargement of the wrapped aortic aneurysm and no stenosis of the visceral branches. This result suggests that our wrapping method is useful to reinforce the wall of small aortic aneurysms.