Long-Term Outcomes of Bioprosthetic or Mechanical Valve Replacement in End-Stage Renal Disease: A Nationwide Population-Based Retrospective Study

Abstract

Background: Valve replacement is associated with worse outcomes in individuals who have end-stage renal disease (ESRD) and require a long-term renal replacement therapy. Prosthetic valve selection in patients with ESRD has remained controversial.Objective: We aimed to investigate long-term outcomes of mechanical and bioprosthetic valve replacement in individuals with ESRD.Methods: We conducted a population-based retrospective cohort study using data obtained from the Taiwan National Health Insurance Research Database. In total, 10,202 patients, including 912 ESRD and 9,290 non-ESRD patients, were selected after a 1:1 propensity-score matching based on the type of prosthetic valve used. The long-term mortality outcomes were then analyzed.Results: During a median follow-up period of 59.6 months, the Kaplan–Meier survival analysis revealed that ESRD patients who underwent mechanical valve replacement had higher rates of all-cause mortality and CV deaths than those who underwent bioprosthetic valve replacement (Log-rank test, p = 0.03 and 0.02, respectively). Multivariable regression analyses demonstrated that ESRD patients who underwent bioprosthetic valve replacement had lower rates of all-cause mortality (p < 0.001, hazard ratio: 0.88, 95% confidence interval: 0.82–0.93) and cardiovascular (CV) death (p < 0.001, hazard ratio: 0.83, 95% confidence interval: 0.76–0.90) than those who had mechanical valve replacement.Conclusion: Bioprosthetic valve replacement is significantly associated with lower rates of all-cause mortality and CV death in the ESRD population.

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

“…A mechanical valve is recommended in patients aged <50 years in America and <60 years in Europe, respectively. Large retrospective studies found that biological valves have comparable rates of survival and valve-related reoperation with mechanical valves in ESKD patients who need dialysis, with lower bleeding and thromboembolic events [ 36 , 37 ]. However, calciphylaxis can occur rapidly in a few cases [ 17 , 20 ], and even in patients with biological valves [ 16 ].…”

Should vitamin K antagonists ever be used in ESRD?

“…Unfortunately, as in the patient presented above, these newer agents are not approved for anticoagulation in patients with mechanical heart valves. Thus in ESRD patients requiring cardiac valve replacement, it is probably prudent, whenever possible, to place bioprosthetic valves, which may have better outcomes in this population anyway 24 …”