Key result
Mechanical valves are linked to ~17% lower mortality in AVR but comparable survival in mitral replacement.
Why the study?
Limited literature exists evaluating outcomes of kidney transplant-eligible patients on dialysis who undergo valve replacement, particularly comparing bioprosthetic and mechanical valves.
Does bioprosthetic valve replacement compared to mechanical valve replacement improve mortality, reoperation, or bleeding in kidney transplant candidates on dialysis?
Observational (n=2,812)
Yes
Does bioprosthetic valve replacement compared to mechanical valve replacement improve mortality, reoperation, or bleeding in kidney transplant candidates on dialysis?
Effect estimate: HR 0.92 (95% CI 0.77-1.09)
In kidney transplant candidates on dialysis, bioprosthetic and mechanical valves have generally comparable survival, reoperation, and bleeding rates, supporting individualized valve selection.
Supports individualized valve selection in dialysis patients; extends observational data but leaves optimal AVR choice open for trials.
Background Limited literature exists that evaluated outcomes of kidney transplant-eligible patients who are having dialysis and who are undergoing valve replacement. Our main objective in this study was to compare mortality, reoperation, and bleeding episodes between bioprosthetic and mechanical valve procedures among kidney transplant-eligible patients who are having dialysis. Methods and Results We studied 887 and 1925 dialysis patients from the United States Renal Data System, who underwent mitral valve replacement and aortic valve replacement (AVR) after being waitlisted for a kidney transplant (2000-2015), respectively. Time to death, time to reoperation, and time to bleeding requiring hospitalizations were compared separately for AVR and mitral valve replacement. Kaplan-Meier survival curves, Cox proportional hazards model for time to death, accelerated time to event model for time to reoperation, and counting process model for time to recurrent bleeding were used. There were no differences in mortality (hazard ratio [HR], 0.92; 95% CI, 0.77-1.09) or risk of reoperation or risk of significant bleeding events between bioprosthetic and mechanical mitral valve replacement. However, mechanical AVR was associated with a modestly significant less hazard of death (HR, 0.83; 95% CI, 0.74-0.94) compared with bioprosthetic AVR. There were no differences in time to reoperation, or time to significant bleeding events between bioprosthetic and mechanical AVR. Conclusions For kidney transplant waitlisted patients who are on dialysis and who are undergoing surgical valve replacement, bioprosthetic and mechanical valves have comparable survival, reoperation rates, and bleeding episodes requiring hospitalizations at both mitral and aortic locations. These findings emphasize that an individualized informed decision is recommended when choosing the type of valve for this special group of patients having dialysis.
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Ngendahimana et al. (2021) conducted an observational in Kidney transplant candidates on dialysis requiring valve replacement (n=2,812). Mechanical valve replacement vs. Bioprosthetic valve replacement was evaluated on Mortality (mitral valve replacement) (HR 0.92, 95% CI 0.77-1.09). Mechanical and bioprosthetic valves showed comparable mortality for mitral replacement (HR 0.92; 95% CI 0.77-1.09), while mechanical AVR had a lower hazard of death (HR 0.83; 95% CI 0.74-0.94).
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