AUTHOR=Li Guan-Yi , Chen Yun-Yu , Chung Fa-Po , Chien Kuo-Liong , Hsu Chiao-Po , Lin Yenn-Jiang 

TITLE=Long-Term Outcomes of Bioprosthetic or Mechanical Valve Replacement in End-Stage Renal Disease: A Nationwide Population-Based Retrospective Study

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=8

YEAR=2021

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2021.745370

DOI=10.3389/fcvm.2021.745370

ISSN=2297-055X

ABSTRACT=<p><bold>Background:</bold> Valve replacement is associated with worse outcomes in individuals who have end-stage renal disease (ESRD) and require a long-term renal replacement therapy. Prosthetic valve selection in patients with ESRD has remained controversial.</p><p><bold>Objective:</bold> We aimed to investigate long-term outcomes of mechanical and bioprosthetic valve replacement in individuals with ESRD.</p><p><bold>Methods:</bold> We conducted a population-based retrospective cohort study using data obtained from the Taiwan National Health Insurance Research Database. In total, 10,202 patients, including 912 ESRD and 9,290 non-ESRD patients, were selected after a 1:1 propensity-score matching based on the type of prosthetic valve used. The long-term mortality outcomes were then analyzed.</p><p><bold>Results:</bold> During a median follow-up period of 59.6 months, the Kaplan–Meier survival analysis revealed that ESRD patients who underwent mechanical valve replacement had higher rates of all-cause mortality and CV deaths than those who underwent bioprosthetic valve replacement (Log-rank test, <italic>p</italic> = 0.03 and 0.02, respectively). Multivariable regression analyses demonstrated that ESRD patients who underwent bioprosthetic valve replacement had lower rates of all-cause mortality (<italic>p</italic> &lt; 0.001, hazard ratio: 0.88, 95% confidence interval: 0.82–0.93) and cardiovascular (CV) death (<italic>p</italic> &lt; 0.001, hazard ratio: 0.83, 95% confidence interval: 0.76–0.90) than those who had mechanical valve replacement.</p><p><bold>Conclusion:</bold> Bioprosthetic valve replacement is significantly associated with lower rates of all-cause mortality and CV death in the ESRD population.</p>