Aortic valve prosthesis selection in dialysis patients based on the patient’s condition

Abstract

Previous studies have examined outcomes in dialysis patients undergoing cardiac surgery. However, only a few studies have solely focused on outcomes after aortic valve replacement (AVR). This study aimed to clarify independent predictors of the long-term survival of dialysis patients with AVR and to determine whether a mechanical valve or bioprosthesis is suitable based on the patient's condition. A total of 38 consecutive dialysis patients who underwent AVR at our institute were reviewed (mean age 69.1 ± 9.4 years). There were 23 bioprostheses and 15 mechanical valve replacements. The operative mortality and the long-term survival were not different between the bioprosthesis and the mechanical valve group (13.0 vs. 13.3%). The significant multivariate predictors for long-term survival were concomitant coronary artery bypass grafting (CABG) and prosthesis size. Valve types and age at operation did not affect long-term survival. Five-year survival of patients with small prosthetic valves and concomitant CABG was 0%. When the patient's quality of life is taken into account, it may be appropriate to use a bioprosthesis in a dialysis patient with a small annulus and concomitant CABG even if the patient is young.

Tissue valves are preferable for patients with end-stage renal disease: an aggregate meta-analysis

“…After excluding duplicates, from 452 initial search results, 201 relevant abstracts were identified for secondary review. Finally, 15 retrospective studies fulfilled our inclusion criteria (Figure ). Two studies were excluded as they only selected patients with infective endocarditis.…”

“…In 5523 and 1600 patients undergoing mechanical valve and biological valve replacement, respectively, 4115 aortic and 2112 mitral valves were replaced; there was variability in the specific valve type among the studies included. Three studies reported results of isolated aortic valve replacement. The duration of preoperative dialysis was reported in seven studies .…”

“…Three studies reported results of isolated aortic valve replacement. The duration of preoperative dialysis was reported in seven studies . Tables and demonstrate the preoperative demographics for the patients included in the studies included in our review.…”

“…Early/in‐hospital mortality was reported in all 15 studies . Four studies failed to report separate results for the mechanical and tissue valve cohorts; hence, they could not be included in our analysis.…”

Bioprosthetic versus Mechanical Prostheses for Valve Replacement in End-stage Renal Disease Patients: Systematic review and meta-analysis

“…After exclusion of duplicate or irrelevant references, 40 potentially relevant articles were retrieved. After application of inclusion and exclusion criteria, 16 relevant articles were included in the present systematic review and meta-analysis (7,(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24). A total of 8,483 patients with ESRD were included for analysis, including 6,187 receiving bioprosthesis and 2,296 receiving mechanical valves.…”