Long-term outcomes of aortic valve replacement in dialysis patients – a nationwide retrospective cohort study

Figure 1. Flow diagram of the selection and matching of study cohort. Patients who underwent first-time cardiac valve replacement between 2001 and 2018 in the National Health Insurance Research Database were screened for eligibility. A study cohort of 891 dialysis patients who received primary surgical aortic valve replacement was analyzed. Using propensity score matching, the long-term outcome was compared between 243 patients with a bioprosthesis and 243 patients with a mechanical valve.

Figure 2. (A) Long-term survival among propensity-matched dialysis patients. The overall survival and estimated restricted mean survival time after primary surgical aortic valve replacement are depicted and compared between the two types of prosthetic valves. The group of patients who received a mechanical valve was the reference group. The numbers of patients at risk are included below each graph. (B) Major adverse event-free survival among propensity-matched dialysis patients. The major adverse event-free survival and estimated major adverse event-free survival days after primary surgical aortic valve replacement are depicted and compared between the two types of prosthetic valves. The group of patients who received a mechanical valve was the reference group. The numbers of patients at risk are included below each graph. RMST, restricted mean survival time; RMTL, restricted mean time lost.

Figure 3. (A) Subgroup analysis stratified by age. A 2-year survival gain in favor of mechanical prostheses was identified in dialysis patients younger than 50 years. (B) Long-term survival among propensity-matched dialysis patients younger than 50 years. The overall survival in patients younger than 50 years after primary surgical aortic valve replacement is depicted and compared between the two types of prosthetic valves. The group of patients who received a mechanical valve was the reference group. The numbers of patients at risk are included below each graph. EST, estimate; RMST, restricted mean survival time.