Tissue valves for aortic valve replacement in ESRD patients had higher early mortality than mechanical valves (16.2% vs. 4.0%; p=0.008), but long-term survival did not differ significantly.
Cohort (n=474)
Yes
Does tissue valve replacement compared to mechanical valve replacement improve survival in patients with end-stage renal disease undergoing aortic valve replacement?
In patients with ESRD undergoing AVR, tissue and mechanical valves offer comparable long-term survival, suggesting valve choice should be individualized based on shared decision-making rather than defaulting to mechanical valves.
Absolute Event Rate: 16.2% vs 4%
p-value: p=0.008
Background: Earlier studies in patients with end-stage renal dysfunction (ESRD) reported no significant difference in long-term outcomes between mechanical and tissue valves after valve surgery, largely due to the limited life expectancy of this population. As survival in patients with ESRD has improved in recent years, this study evaluated whether increased life expectancy affects long-term outcomes according to valve type in patients with ESRD undergoing aortic valve replacement (AVR) using a nationwide cohort. Methods: We analyzed data from the Korean National Health Insurance Service database from January 2005 to December 2021. Among 474 patients with ESRD who underwent AVR, 279 received tissue valves and 195 received mechanical valves. Propensity score matching was performed to balance baseline characteristics, yielding 99 matched patient pairs. Results: In the matched cohort, early mortality (within 30 days) was significantly higher in the tissue valve group (16.2% vs. 4.0%; p = 0.008). However, long-term survival rates at 1, 5, and 10 years did not differ significantly between the groups (all p > 0.05). Stratification by operative era (2005–2013 vs. 2014–2021) similarly showed no significant impact of valve type on survival despite temporal advances in care. Conclusions: Long-term survival and complication rates after AVR in patients with ESRD were comparable between mechanical and tissue valves across operative eras. Valve selection should be guided by shared decision-making, incorporating individual life expectancy and comorbidity profiles rather than assuming mechanical valves as the default option.
Song et al. (Mon,) conducted a cohort in End-stage renal disease requiring aortic valve replacement (n=474). Tissue valve vs. Mechanical valve was evaluated on Early mortality (within 30 days) (p=0.008). Tissue valves for aortic valve replacement in ESRD patients had higher early mortality than mechanical valves (16.2% vs. 4.0%; p=0.008), but long-term survival did not differ significantly.