title: Should we use mechanical valves in patients with end-stage renal disease?
abstract: A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether a mechanical or bioprosthetic valve is superior for immediate and long-term survival in patients with end-stage renal disease (ESRD) undergoing a valve replacement. Altogether more than 150 papers were found using the reported search; of which, eight represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. There were no randomized controlled trials addressing the question. There was one systematic review and meta-analysis. All the other evidence was in the form of retrospective studies. The papers show that there is no significant difference in the results and survival between patients receiving a mechanical and those receiving a bioprosthetic valve. This was seen in the meta-analysis as well as the larger series of patients who underwent valve replacement. Bleeding complications were more common with mechanical valves. We conclude that the choice of valve for patients with ESRD should be determined by age, level of activity and patient choice. Due to the limited life expectancy of these patients, bioprosthetic valves should be considered, especially since there is no evidence of early degeneration of tissue valves in this subgroup of patients.
authors.affiliation: Department of Cardiothoracic Surgery, Heart Hospital , University College London Hospital, London, UK. vasudevpai@gmail.com
authors.forename: Vasudev B
authors.initials: VB
authors.lastname: Pai
authors.forename: Cheh Kuan
authors.initials: CK
authors.lastname: Tai
authors.forename: Kunal
authors.initials: K
authors.lastname: Bhakri
authors.forename: Shyam
authors.initials: S
authors.lastname: Kolvekar
mesh_terms: D019985:Benchmarking; D001705:Bioprosthesis; D019317:Evidence-Based Medicine; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications / Q000401:mortality / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011474:Prosthesis Design; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome