Prosthesis selection for aortic valve replacement in patients on hemodialysis

Abstract

Objective

The purpose of this study was to evaluate the outcomes of prosthesis selection in hemodialysis patients undergoing valve replacement for aortic valve stenosis.

Methods

From July 2008 to December 2016, 76 patients on hemodialysis underwent aortic valve replacement for aortic valve stenosis. Of these patients, 30 patients were treated by a mechanical valve and 46 patients were treated by a bioprosthesis. Early outcomes and long-term outcomes were compared.

Results

The mean age of the patients treated by a mechanical valve was younger than the patients treated by a bioprosthesis (p < 0.001). There were no significant differences in in-hospital mortality (p = 0.52). For the long-term outcomes, complications associated with bleeding were higher in patients who received a mechanical valve (p = 0.032). However, no significant difference was observed in mortality (p = 0.65) and major adverse cardiovascular cerebrovascular event (MACCE: p = 0.59). The actuarial survival rate with a mechanical valve was 56.7% (95% CI 36.4–72.8%) at 3 years and 48.6% (95% CI 28.9–65.8%) at 5 years. The actuarial survival rate with a bioprosthesis was 61.2% (95% CI 44.0–74.5%) at 3 years and 39.5% (95% CI 20.9–57.8%) at 5 years. No patients from both groups needed redo surgery for valvular deterioration. Further, there was no significant difference in long-term mortality (p = 0.91) and MACCE (p = 0.63) in a propensity score-matched patient comparison.

Conclusions

Although bleeding complications were higher in patients who received a mechanical valve, there were no significant differences in early- and long-term mortality, and MACCE between patients treated by a mechanical valve and a bioprosthesis.