Long-term outcomes of surgical aortic valve replacement in patients receiving chronic dialysis
Bibliographic record
Abstract
BACKGROUND: Surgical aortic valve replacement (SAVR) has been the standard treatment for symptomatic severe aortic stenosis, which is common among patients receiving long-term dialysis. The aim of this study was to report the long-term outcomes of SAVR in patients receiving chronic dialysis and to identify independent risk factors for early and late mortality. METHODS: Every consecutive patient with SAVR with or without concomitant cardiac procedures in British Columbia between January 2000 and December 2015 was identified from the provincial cardiac registry. The Kaplan-Meier method was used to estimate survival. Univariate and multivariable models were conducted to determine independent risk factors for short-term mortality and reduced long-term survival. RESULTS: Between 2000 and 2015, 654 patients receiving dialysis underwent SAVR with or without concomitant procedures. The mean follow-up was 2.3 (standard deviation 2.4) years (median 2.5 yr). The overall 30-day mortality was 12.8%. The 5-year and 10-year survival rates were 45.6% and 23.5%, respectively. Twelve patients (1.8%) had redo aortic valve surgery. There was no difference in 30-day mortality or long-term survival between 2 age groups (> 65 yr v. ≤ 65 yr). Anemia and cardiopulmonary bypass (CPB) were independent risk factors for both longer hospital stay and reduced long-term survival. The impact of CPB pump time on mortality occurred mainly within the first 30 days after surgery. When CPB pump time extended beyond 170 minutes, there was a significant increase in 30-day mortality with further prolongation of CPB pump time, and the relationship between 30-day mortality and CPB pump time became approximately linear. CONCLUSION: Patients receiving dialysis have poor long-term survival with a very low rate of redo aortic valve surgery following SAVR with or without concomitant procedures. Older age (> 65 yr) is not an independent risk factor for either 30-day mortality or reduced long-term survival. Using alternative strategies to limit CPB pump time is an important way to reduce 30-day mortality.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".