Hemorrhage as a life-threatening complication after valve replacement in end-stage renal disease patients

Nakatsu, Taro; Tamura, Nobushige; Yanagi, Shigeki; Kyo, Shoichi; Koshiji, Takaaki; Sakata, Ryuzo

doi:10.1007/s11748-015-0551-x

Cited by 10 publications

(25 citation statements)

References 21 publications

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“…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.…”

Section: Resultsmentioning

confidence: 99%

“…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.…”

Section: Resultsmentioning

confidence: 99%

“…Early mortality was 13.9% and 15.2% for the mechanical valve and biological valve cohorts, respectively. Thus, postoperative survival was comparable after both mechanical and tissue valve replacement (OR 1.15 [0.77; 1.72]; p = 0.49). Heterogeneity was absent in this analysis (I 2 = 0% [0%; 46.6%]).…”

Section: Early Mortality (Figure )mentioning

confidence: 98%

“…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.…”

Section: Early Mortality (Figure )mentioning

confidence: 99%

“…Late bleeding episodes were reported in 11 studies . Mechanical valves had significantly higher bleeding rates (19.6%) compared to biological valves (6.9%).…”

Section: Bleeding Event (Figure )mentioning

confidence: 99%

See 4 more Smart Citations

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

Altarabsheh

Deo²,

Dunlay

et al. 2016

J Card Surg

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Early Mortality (Figure )mentioning

confidence: 98%

Section: Early Mortality (Figure )mentioning

confidence: 99%

“…Late bleeding episodes were reported in 11 studies . Mechanical valves had significantly higher bleeding rates (19.6%) compared to biological valves (6.9%).…”

Section: Bleeding Event (Figure )mentioning

confidence: 99%

See 3 more Smart Citations

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

Altarabsheh

Deo²,

Dunlay

et al. 2016

J Card Surg

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Intermediate-term outcomes of aortic valve replacement with bioprosthetic or mechanical valves in patients on hemodialysis

Nakatsu

Minakata

Tanaka

et al. 2019

The Journal of Thoracic and Cardiovascular Surgery

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Objective: To investigate the influence of choice of prosthesis (bioprosthetic valves or mechanical valves) on intermediate-term outcomes in patients on hemodialysis undergoing aortic valve replacement (AVR).Methods: A multi-institutional retrospective cohort study was conducted in 18 Japanese centers. All adult patients on chronic hemodialysis who underwent AVR from 2008 and 2015 were included (n ¼ 491). The early and late results were compared between groups. The hazard ratios were calculated using Cox regression and Fine-Gray models with adjustment for propensity score based on 41 confounders. The mean follow-up period was 2.5 AE 2.1 years (up to 8.3 years) with 98% completeness.Results: There were 323 patients who received a bioprosthetic valve (group B), and 168 patients who received a mechanical valve (group M). There was no significant difference for in-hospital death rate between groups (group B: 12.1%; group M: 8.9%; P ¼ .29). The overall survival rate at 5 years after surgery was 39.3% in group B and 50.4% in group M (P ¼ .42). Freedom from reoperation at 5 years was 97.1% in group B and 97.8% in group M (P ¼ .88). On propensity-score adjusted analyses, there were no significant differences in overall survival between groups.Conclusions: There were no significant differences in overall survival between bioprosthetic valves and mechanical valves in patients on hemodialysis undergoing AVR.

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Mechanical or biological heart valve for dialysis-dependent patients? A meta-analysis

Chiang

Kang

et al. 2022

The Journal of Thoracic and Cardiovascular Surgery

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Objective: The optimal selection of prosthetic heart valve for dialysis-dependent patients remains controversial. We investigated the comparative effectiveness and safety of mechanical prosthesis (MP) and bioprosthesis (BP) for these patients.Methods: After the systematic review, we included studies that involved patients on dialysis undergoing aortic valve replacement or mitral valve replacement (MVR) and reported comparative outcomes of MP and BP. Meta-analysis was performed using random-effects model. We conducted a subgroup analysis based on the valve position and postoperative international normalized ratio (INR), which was extracted from either tables or methods of each study. A meta-regression was used to examine the effects of study-level covariates.Results: We included 24 retrospective studies without randomized-controlled trials, involving 10,164 participants (MP ¼ 6934, BP ¼ 3230). Patients undergoing aortic valve replacement with MP exhibited a better long-term survival effectiveness (hazard ratio, 0.64; 95% confidence interval [CI], 0.47-0.86). Conversely, studies including MVR demonstrated little difference in survival (hazard ratio, 0.90; 95% CI, 0.73-1.12). A meta-regression revealed that age had little effect on long-term survival difference between MP and BP (b ¼ -0.0135, P ¼ .433). MP had a significantly greater bleeding risk than did BP when INR was above 2.5 (incidence rate ratio, 10.58; 95% CI, 2.02-55.41). However, when INR was below 2.5, bleeding events were comparable (incidence rate ratio, 1.73; 95% CI, 0.78-3.82). The structural valve deterioration rate was significantly lower in MP (risk ratio, 0.24; 95% CI, 0.14-0.44).Conclusions: MP is a reasonable choice for dialysis-dependent patients without additional thromboembolic risk requiring aortic valve replacement, for its better long-term survival, durability, and noninferior bleeding risk compared with BP. Conversely, BP might be an appropriate selection for patients with MVR, given its similar survival rate and lower bleeding risk. Although our meta-regression demonstrates little influence of age on long-term survival difference between MP and BP, further studies stratifying patients based on age cut-off are mandatory.

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Hemorrhage as a life-threatening complication after valve replacement in end-stage renal disease patients

Cited by 10 publications

References 21 publications

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

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

Intermediate-term outcomes of aortic valve replacement with bioprosthetic or mechanical valves in patients on hemodialysis

Mechanical or biological heart valve for dialysis-dependent patients? A meta-analysis

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