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. 2019 May;11(5):1996-2005.
doi: 10.21037/jtd.2019.04.96.

Mechanical versus bioprosthetic valves in patients on dialysis

Patrick G Chan  1 , Ibrahim Sultan  1 , Thomas G Gleason  1 , Forozan Navid  1 , Arman Kilic  1
Affiliations

Mechanical versus bioprosthetic valves in patients on dialysis

Patrick G Chan et al. J Thorac Dis. 2019 May.

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 (12.7%) versus mechanical (5.9%) 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.

Keywords: Dialysis; aortic valve; mitral valve; survival; valve replacement.

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Conflict of interest statement

Conflicts of Interest: TG Gleason—Medical Advisory Board, Abbott; A Kilic—Medical Advisory Board, Medtronic, Inc.The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Freedom from mortality.
Figure 2
Figure 2
Freedom from inpatient readmission.
Figure 3
Figure 3
Freedom from re-hospitalization for bleeding.
See this image and copyright information in PMC

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