Article Abstract

Mechanical versus bioprosthetic valves in patients on dialysis

Authors: Patrick G. Chan, Ibrahim Sultan, Thomas G. Gleason, Forozan Navid, Arman Kilic

Abstract

Background: The aim of this study is to evaluate the outcomes of bioprosthetic versus mechanical valves in patients on dialysis.
Methods: All patients who underwent aortic (AVR) or mitral valve replacement (MVR) at a single institution from 2011–2017 were reviewed. Primary stratification was bioprosthetic versus mechanical valves. The primary outcome was all-cause mortality. Secondary outcomes included hospital readmission, valve reoperation rates and bleeding events. Kaplan-Meier curves were generated and Cox proportional hazards regression models were used for risk-adjustment.
Results: During the study period, 3,969 patients underwent AVR or MVR, of which 97 (2.4%) were on dialysis. In dialysis patients, unadjusted 30-day mortality was comparable between bioprosthetic (13%) versus mechanical (6%) valves (P=0.31). However, the bioprosthetic group had higher rates of 1-year (40.3% versus 15.2%; P=0.03) and 5-year mortality (67.9% versus 60.7%; P=0.02). Most patients were readmitted within 5 years with no differences between the groups (bioprosthetic 80.3% versus mechanical 100%; P=0.57). There were no valve reoperations in either group at 5 years. The 5-year readmission rate was higher in the mechanical cohort (10.5% versus 53.8%; P=0.05). Risk-adjusted analysis confirmed these findings, where mechanical valves were independently associated with reduced mortality at 1-year and 5-years.
Conclusions: Despite the limited life expectancy of patients on dialysis, mechanical valves have an intermediate term mortality benefit compared to bioprosthetic valves. This comes at the expense of a higher rate of readmission for bleeding. Although valve choice should consider multiple factors, these data suggest that mechanical valve usage in dialysis patients is reasonable.

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