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

Abstract

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.

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

“…9,10 However, considerable heterogeneity has remained unexplored, and the effects of the valve position and postoperative anticoagulation protocol have still not been clarified. Furthermore, recent publications differ in their outcomes, with Chan and colleagues 11 favoring MPs over BPs regarding long-term survival rates, and Nakatsu and colleagues, 12 Hori and colleagues, 13 Manghelli and colleagues, 14 and Ikeno and colleagues 15 concluding that the survival difference is negligible. Therefore, we integrated every relevant study to update the comparative effectiveness and safety of MPs and BPs in dialysis-dependent patients.…”

Commentary: Tissue is the issue—Bioprosthetic versus mechanical valves in dialysis-dependent patients

“…Reduced thrombotic complications also contradict the findings of Nakatsu and colleagues, 5 who recently examined 491 dialysis-dependent patients requiring mechanical versus bioprosthetic AVR across 18 Japanese centers and found no difference in thromboembolic events at 5-year follow-up. In contrast to Ikeno and colleagues 4 and colleagues, Nakatsu and colleagues 5 focused on patients requiring AVR, and their larger sample size may have allowed them better to capture a representative sample of this specific subpopulation, without necessarily offering generalizability to patients requiring mitral valve replacement or double valve replacement.…”

Rapid-Deployment Aortic Valve Replacement for a Hemodialysis Patient with Prior Coronary Artery Bypass Grafting

“…Patients on dialysis have a limited lifespan, but mechanical valves are superior to biological valves for midterm results [Greason 2014]. Rehospitalization due to bleeding was a little more frequent with mechanical valves, but Chan et al [2019] reported that the use of mechanical valves in patients on dialysis is appropriate Chan et al [2019] compared 323 patients with a biological valve and 168 patients with a mechanical valve and reported no significant differences in in-hospital mortality, 5-year postoperative survival, or 5-year reoperation-free rate Nakatsu et al [2019]. We believe that multiple factors should be considered when choosing a valve for patients with aortic valve stenosis on hemodialysis.…”