Valve surgery in renal dialysis patients.
OBJECTIVE
Mechanical valves are used in dialysis patients due to the presumed rapid degeneration of tissue valves. The study aim was to compare the results of mechanical and tissue valves placed in renal dialysis patients.


METHODS
Information obtained from a computer-based valve replacement database, telephone interviews and patient charts was reviewed for follow up data.


RESULTS
Between 1991 and 2004, 50 dialysis patients underwent left-sided valve replacement. Of these patients, 17 received 21 St. Jude Medical mechanical valves (12 aortic, nine mitral), and 33 received 39 tissue valves (19 aortic, 20 mitral). The mean follow up for the mechanical and tissue valve groups was 19.4 +/- 21.3 and 21.4 +/- 18.7 months, respectively. Mortality at four years was 65% (11/17) for the mechanical valve group, and 42% (14/33) for the tissue valve group (p = 0.15). Freedom from reoperation was not significantly different. The tissue valve group had significantly higher Kaplan-Meier freedom from thromboembolism (100% versus 75 +/- 15%, p = 0.01), hemorrhage (97 +/- 3% versus 44 +/- 17%, p = 0.002), valve-related morbidity (74 +/- 9% versus 42 +/- 16%, p = 0.043), and valve-related morbidity and mortality (69 +/- 9% versus 37 +/- 14%, p = 0.037) at three years. Linearized rates of hemorrhage (21 versus 2%/pt-yr; p = 0.005), valve-related morbidity (36 versus 12%/pt-yr; p = 0.02) and valve-related morbidity and mortality (50 versus 17%/pt-yr; p = 0.008) were all significantly higher in the mechanical valve group.


CONCLUSIONS
Dialysis patients had poor survival; prosthetic valve degeneration was negligible. Incidences of thromboembolism, bleeding and valve-related morbidity and mortality were higher with mechanical valves. Linearized, as opposed to actuarial, analysis further accentuated the unacceptably high rates of complications and death with mechanical valves.
Toole
J Matthew
JM
Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, South Carolina 29425, USA.
Stroud
Martha R
MR
Kratz
John M
JM
Crumbley
Arthur J
AJ
Crawford
Fred A
FA
Ikonomidis
John S
JS
D001705:Bioprosthesis / Q000706:statistics & numerical data; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000706:statistics & numerical data*; D006801:Humans; D007407:Interviews as Topic; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy*; D008297:Male; D017582:Renal Replacement Therapy; D012189:Retrospective Studies; D016019:Survival Analysis