Long-term survival of dialysis patients in the United States with prosthetic heart valves: should ACC/AHA practice guidelines on valve selection be modified?
BACKGROUND
Minimal data exist on the long-term survival of dialysis patients after cardiac valve surgery. Current practice guidelines of the American College of Cardiology/American Heart Association Task Force on the management of patients with valvular heart disease proscribe the use of bioprosthetic (tissue) valves in hemodialysis patients.


RESULTS
Dialysis patients hospitalized for heart valve replacement surgery from 1978 to 1998 were retrospectively identified from the US Renal Data System database. Long-term survival was estimated by the life-table method. The impact of demographic differences and comorbidity on outcome were examined in a Cox proportional hazards model. The in-hospital mortality of 5858 dialysis patients undergoing valve surgery was 20.7%. Aortic valve replacement was performed in 3415 patients (58%), mitral valve replacement in 1848 patients (32%), and combined aortic and mitral valve replacement in 562 patients (10%). Tissue valves were used in 881 patients. There was no significant difference in survival related to type of prosthetic valve. The 2-year survival rate was 39.7+/-3.5% with tissue valves versus 39.7+/-1.4% for nontissue valves. Compared with nontissue prosthetic valves, the use of tissue valves was not predictive of death (RR 0.98; 95% CI 0.90 to 1.07).


CONCLUSIONS
There is no significant difference in survival of dialysis patients after cardiac valve replacement with tissue versus nontissue prosthetic valves. Current practice guidelines proscribing the use of bioprosthetic heart valves in hemodialysis patients should be rescinded.
Herzog
Charles A
CA
Cardiovascular Special Studies Center, US Renal Data System, Department of Internal Medicine, Division of Cardiology, University of Minnesota, Minneapolis 55415, USA. herzo003@umn.edu
Ma
Jennie Z
JZ
Collins
Allan J
AJ
D000328:Adult; D000368:Aged; D001705:Bioprosthesis / Q000009:adverse effects; D015897:Comorbidity; D003710:Demography; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000401:mortality / Q000601:surgery; D006350:Heart Valve Prosthesis / Q000009:adverse effects; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015996:Survival Rate; D017741:Survivors / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology