Calciphylaxis After Aortic Valve Replacement in a Patient with End-Stage Renal Disease

Abstract

In this study, we report a case of a patient on dialysis who presented necrotic lesions on the legs and penile ulceration 7 years after a mechanical aortic valve replacement. The diagnosis of calciphylaxis was not confirmed even after skin biopsy, and multidisciplinary management was not initiated until the patient was admitted with septic shock. Cardiovascular surgeons should be aware of warfarin-induced calciphylaxis, whose pathophysiology differs from that of atherosclerosis. Considering poor long-term survival of dialysis patients, mechanical valves should be reserved only for those patients whose estimated survival is longer than the time taken for a biological valve to deteriorate.

Sailing between scylla and charybdis—anticoagulation dilemma in a patient with calciphylaxis and mechanical cardiac valve replacement: a case report and literature review

“…The clinical scenarios and prognosis of anticoagulation therapy in ESKD patients with calciphylaxis also vary from person to person ( Table 1 ). Some reported a significant clinical improvement after changing warfarin into unfractionated heparin [ 20 ] or enoxaparin [ 19 ], however, in some cases, the lesion still progressed even after the anticoagulation regimen was altered or halted [ 18–20 ]. Warfarin was proved to have a higher risk of all‐cause hospitalization in ESKD patients with AF [ 21 ], there is need to look for alternatives.…”

“…Some researchers believe that the biological valves might be better in prosthetic valve selection in ESKD patients [ 13 , 18 ]. They deem that the hemodialysis-dependent patients experiencing the valve replacement might have a poorer prognosis than normal patients, and biological valves might be better to avoid further comorbidities.…”