eComment. Are mechanical valves better than bioprostheses in patients on dialysis?

Abstract

replacements had a significantly higher rate of postoperative cerebrovascular accidents (18.2%) compared with those with biological replacement (8.3%, P < 0.05). The other bleeding complications were also significantly higher (15.9 versus 11.7%, P < 0.05). The authors concluded that biological valves should be the preference as the use of mechanical valves is associated with a significant risk of complications.Chan et al. performed a systematic review and meta-analysis of valve replacement in patients with ESRD on dialysis. Twelve studies, published from 1997 to 2010, were included in this review; of which, nine were used in the meta-analysis. No difference in the survival was observed between the valve types (bioprostheses versus mechanical prostheses; hazard ratio 1.3, 95% CI 1.0-1.9, P = 0.09). However, bioprosthetic valves were associated with a fewer valve-related complications compared with mechanical prostheses (odds ratio 0.4, 95% CI 0.2-0.7, P = 0.002). They concluded that there was no survival difference following valve replacement with either bioprostheses or mechanical prostheses in patients with ESRD on dialysis. Bioprosthetic valve replacement was associated with fewer valve-related complications. CLINICAL BOTTOM LINEWe conclude that the choice of valve in the patients with ESRD should be determined by age, level of activity and patient choice. There is no sufficient evidence to recommend mechanical or tissue valves. Due to the limited life expectancy of these patients, bioprosthetic valves should be considered especially since there is no evidence of early degeneration of tissue valves in this subgroup of patients.

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

“…There have been gradual changes in recommendations regarding the appropriate valve replacement in patients with ESRD. Early reports demonstrated accelerated degeneration for tissue valves implanted in these patients, hence the guidelines published by Bonow et al in 1998 favored the choice of mechanical prosthesis in this cohort . However, it may be difficult to maintain appropriate anti‐coagulation in these patients as they have a higher risk of bleeding during hemodialysis.…”