1. Outcomes of valve replacement with mechanical prosthesis versus bioprosthesis in dialysis patients: A 16-year multicenter experience.
- Author
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Ikeno Y, Mukohara N, Fukumura Y, Tobe S, Gan K, Obo H, Yoshida K, and Okita Y
- Subjects
- Aged, Female, Humans, Japan epidemiology, Kidney Failure, Chronic complications, Kidney Failure, Chronic mortality, Kidney Failure, Chronic therapy, Male, Middle Aged, Reoperation adverse effects, Reoperation mortality, Reoperation statistics & numerical data, Retrospective Studies, Survival Analysis, Treatment Outcome, Bioprosthesis adverse effects, Bioprosthesis statistics & numerical data, Heart Valve Prosthesis adverse effects, Heart Valve Prosthesis statistics & numerical data, Heart Valve Prosthesis Implantation adverse effects, Heart Valve Prosthesis Implantation instrumentation, Heart Valve Prosthesis Implantation methods, Heart Valve Prosthesis Implantation mortality, Renal Dialysis adverse effects, Renal Dialysis mortality, Renal Dialysis statistics & numerical data
- Abstract
Objective: To evaluate the long-term outcomes of heart valve replacement with mechanical prosthesis (MP) versus bioprosthesis (BP) in patients on dialysis., Methods: A retrospective review was performed at 7 hospitals. Patients on dialysis who underwent valve replacement were included. Survival, reoperation, bleeding, and embolic events were compared across the MP and BP groups., Results: Between April 2000 and April 2016, 312 patients on dialysis were enrolled in our study (MP: 94 patients [30.1%], BP: 218 patients [69.9%]). Mean follow-up was 3.4 ± 3.6 years. Five-year and 10-year survival rates were similar in both groups (MP: 57.4 ± 5.5% at 5 years and 46.3 ± 6.4% at 10 years, BP: 50.2 ± 4.1% at 5 years and 38.8 ± 4.5% at 10 years, P = .305). Multivariate Cox hazard analysis demonstrated that diabetic nephropathy (hazard ratio [HR], 1.90; 95% confidence interval [CI], 1.31-2.73, P < .001), New York Heart Association functional classification ≥III (HR, 2.16; 95% CI, 1.37-3.35, P = .001), and mitral valve replacement (HR, 2.36; 95% CI, 1.58-3.49, P < .001) were significant risk factors for late death. Valve selection was not a significant risk factor. Freedom from valve-related embolic event at 5 years was significantly lower in the MP group (MP: 88.3 ± 4.3% at 5 years, BP: 97.2 ± 1.6% at 5 years, P = .007). Freedom from valve-related reoperation or hemorrhagic events was similar across both groups., Conclusions: Valve selection was not associated with late survival outcomes in patients on dialysis. However, BP may have an advantage in preventing embolic events without increasing the incidence of valve-related reoperation when compared with MP., (Copyright © 2018 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)
- Published
- 2019
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