Heart valve prosthesis selection in patients with end-stage renal disease requiring dialysis: a systematic review and meta-analysis

Chan, Vincent; Chen, Li; Mesana, Laura; Mesana, Thierry G.; Ruel, Marc

doi:10.1136/heartjnl-2011-300727

Cited by 47 publications

(31 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In addition to the above findings, a meta-analysis of the published literature demonstrates no survival difference following valve replacement with either bioprosthesis or mechanical prosthesis in patients with ESRD on dialysis. Some recent studies reported that early structural valve deterioration was uncommon, even in dialysis patients, but others showed that it occurred even in new-generation bioprosthetic valves [21,22]. In fact, these reports also support our current study, which have similar outcomes than the present paper.…”

Section: Discussionsupporting

confidence: 91%

Should bioprostheses be considered the valve of choice for dialysis-dependent patients?

Qiu

Chen

et al. 2013

J Cardiothorac Surg

View full text Add to dashboard Cite

BackgroundThere is controversy regarding the choice of prosthetic valves in patients with cardiac valve disease and dialysis-dependent patients. This review assesses a 12-year experience and outcomes after valve replacement in patients on chronic preoperative renal dialysis, comparing survival and valve-related outcomes following valve replacement with bioprostheses versus mechanical prostheses in this population in china.MethodsFrom January 1999 and October 2011, 73 consecutive dialysis patients underwent cardiac valve replacement. The patients were divided into two groups: (Group B) bioprosthesis valves were implanted in 38 (52.1%) patients and (Group M) mechanical valves were implanted in 35 (47.9%) patients. Outcome measures included perioperative data, hospital mortality, major postoperative complications, follow-up outcomes, valve related morbidity and late survival.ResultsThere were no significant differences in terms of patient characteristics in the 2 groups. Thirty-three were isolated aortic valve replacements (45.2%); 28 were isolated mitral valve replacements (38.4%); 10 were combined aortic and mitral replacements (13.7%); 2 were combined tricuspid and mitral replacements (2.7%). The overall hospital mortality was 5.5% (n = 4) and was not different between Group B (5.3%) and Group M (5.7%). Low ejection fraction was the only independent predictors of hospital mortality. There was no significant difference between the groups in the overall rate of complications. The overall mean follow-up was 47 ± 23 months. According to the Kaplan-Meier analysis, late mortality, perivalvular leak and freedom from reoperation were similar in patients with mechanical and bioprosthesis valves. The bioprosthesis valve group had significantly higher freedom from thromboembelism-bleeding events (100% versus 77.6 ± 11.0%, p = 0.012), and valve-related morbidity (73.2 ± 10.1% versus 58.1 ± 10.9%, p = 0.035) in 5 years. Kaplan–Meier survival estimates at 1, 3, and 5 years were 0.971, 0.832, and 0.530 in group B, and 0.967, 0.848, and 0.568 in group M.ConclusionsThere is no significant difference in the perioperative morbidity and mortality, late survival of dialysis patients after cardiac valve replacement with bioprostheses versus mechanical valves. In spite of the limited sample size analyzed, its outcome and consistency to several previous reports supports a conclusion that bioprostheses rather than mechanical ones could be a favorable choice for valve replacement needs of renal failure patients.

show abstract

Section: Discussionsupporting

confidence: 91%

Should bioprostheses be considered the valve of choice for dialysis-dependent patients?

Qiu

Chen

et al. 2013

J Cardiothorac Surg

View full text Add to dashboard Cite

show abstract

“…A number of recent studies have demonstrated equivalent survival rates between bioprosthetic and mechanical valves dialysis patients (20). Our meta-analysis also confirms with previous studies by demonstrating the same equivalence of mortality and survival rates among valve prosthesis choice (31).…”

Section: Discussionsupporting

confidence: 89%

Bioprosthetic versus mechanical prostheses for valve replacement in end-stage renal disease patients: systematic review and meta-analysis

Phan

Zhao

Zhou³

et al. 2016

J. Thorac. Dis.

View full text Add to dashboard Cite

Background: Patients with end-stage renal disease (ESRD) indicated for dialysis are increasingly requiring cardiac valve surgery. The choice of bioprosthetic or mechanic valve prosthesis for such patients requires careful risk assessment. A systematic review and meta-analysis was performed to assess current evidence available.Methods: A comprehensive search from six electronic databases was performed from their inception to February 2015. Results from patients with ESRD undergoing cardiac surgery for bioprosthetic or mechanical valve replacement were identified.Results: Sixteen studies with 8,483 patients with ESRD undergoing cardiac valve replacement surgery were included. No evidence of publication bias was detected. Prior angioplasty by percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery was significantly higher in the bioprosthetic group compared to the mechanical group (16.0% vs. 12.0%, P=0.04); all other preoperative baseline patient characteristics were similar. There was no significant difference in 30-day mortality or allcause mortality between the two comparisons. Compared with the mechanical group, the frequency of bleeding (5.2% vs. 6.4%, P=0.04) and risk of thromboembolism (2.7% vs. 12.8%, P=0.02) were significantly lower in the bioprosthetic group. There were similar rates of reoperation and valve endocarditis.Conclusions: The present study demonstrated that patients with ESRD undergoing bioprosthetic or mechanical valve replacement had similar mid-long term survival. The bioprosthetic group had lower rates of bleeding and thromboembolism. Further studies are required to differentiate the impact of valve location.The presented results may be applicable for ESRD patients requiring prosthetic valve replacement.

show abstract

“…26 A recent meta-analysis combined nine studies comparing mechanical and bioprosthetic valves in the ESRD population and found no survival difference but fewer valve-related complications with bioprostheses. 27 …”

Section: Discussionmentioning

confidence: 99%

Long-term Survival of Dialysis Patients With Bacterial Endocarditis Undergoing Valvular Replacement Surgery in the United States

et al. 2013

View full text Add to dashboard Cite

Background Bacterial endocarditis in dialysis patients is associated with high mortality rates. The literature is limited regarding long-term outcomes of valvular replacement surgery and choice of prosthesis in dialysis patients with bacterial endocarditis. Methods and Results Dialysis patients hospitalized for bacterial endocarditis, 2004-2007, were studied retrospectively using data from the US Renal Data System. Long-term survival of patients undergoing valve replacement surgery with tissue or non-tissue valves was compared using the Kaplan-Meier method. A Cox proportional hazards model was used to identify independent predictors of mortality in patients undergoing valvular replacement surgery. During the study period, 11,156 dialysis patients were hospitalized for bacterial endocarditis and 1267 (11.4%) underwent valvular replacement surgery (tissue valve 44.3%, non-tissue valve 55.7%). In the valve replacement cohort, 60% were men, 50% white, 54% aged 45-64 years, and 36% diabetic. Estimated survival with tissue and non-tissue valves, respectively, at 0.5, 1, 2, and 3 years was 59% and 60%, 48% and 50%, 35% and 37%, and 25% and 30% (log rank P = 0.42). Staphylococcus was the predominant organism (66% of identified organisms). Independent predictors of mortality in patients undergoing valve replacement surgery included older age, diabetes as cause of end-stage renal disease, surgery during index hospitalization, staphylococcus as the causative organism, and dysrhythmias as a comorbid condition. Conclusions Valve replacement surgery is appropriate for well-selected dialysis patients with bacterial endocarditis, but is associated with high mortality rates. Survival does not differ with tissue or non-tissue prosthesis.

show abstract

Heart valve prosthesis selection in patients with end-stage renal disease requiring dialysis: a systematic review and meta-analysis

Cited by 47 publications

References 20 publications

Should bioprostheses be considered the valve of choice for dialysis-dependent patients?

Should bioprostheses be considered the valve of choice for dialysis-dependent patients?

Bioprosthetic versus mechanical prostheses for valve replacement in end-stage renal disease patients: systematic review and meta-analysis

Long-term Survival of Dialysis Patients With Bacterial Endocarditis Undergoing Valvular Replacement Surgery in the United States

Contact Info

Product

Resources

About