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.
Highlights
Choosing a prosthetic heart valve can be clinically challenging, and it is commonly based on several factors, such as age, underlying disease requiring the use of anticoagulants, risk of bleeding and thromboembolism, durability of the prosthesis, patients’ preferences, and risk of structural deterioration requiring re-interventions [1, 2]
During a median follow-up period of 59.6 months, the Kaplan–Meier survival analysis revealed that end-stage renal disease (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
Summary
Choosing a prosthetic heart valve can be clinically challenging, and it is commonly based on several factors, such as age, underlying disease requiring the use of anticoagulants, risk of bleeding and thromboembolism, durability of the prosthesis, patients’ preferences, and risk of structural deterioration requiring re-interventions [1, 2]. It has long been established that the abnormal calcium and phosphate metabolism due to ESRD is related to calcification and degenerative valvular lesions, which may be explained by an active regulated process associated with an osteoblast-like phenotype [8,9,10,11]. It results in a major concern regarding structural destruction of the bioprosthetic valves in ESRD. 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
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