title: Tissue valves are preferable for patients with end-stage renal disease: an aggregate meta-analysis.
abstract: BACKGROUND
  Valve selection in patients with end-stage renal disease (ESRD) is uncertain. We performed a systematic review and meta-analysis to compare clinical outcome in ESRD patients undergoing valve replacement.
  
  
  METHODS
  We systematically searched multiple databases (2000-October 2015) to identify original studies comparing adverse events between mechanical and biological valve replacement in ESRD patients. End-points studied were: postoperative mortality, bleeding events, need for re-operation, and late survival. A random-effect inverse-variance weighted analysis was performed; event rates are compared as odds ratio (OR and 95% confidence interval) and hazard ratios (HR) for time-to-event data. Mechanical valve and tissue valve replacement were considered as study and control cohorts, respectively.
  
  
  RESULTS
  Fifteen retrospective studies (5523 mechanical and 1600 tissue valve) were included in our meta-analysis. Early mortality was comparable (OR 1.15 [0.77; 1.72]; p = 0.49). The mean follow-up among studies ranged from 1.6-15 years. Bleeding was significantly higher after mechanical valve replacement (OR 2.55 [1.53; 4.26]; p = 0.0003). Structural valve degeneration was present in only 0.6% patients after a tissue valve replacement. Overall survival after valve replacement was poor (median 2.61 years); valve choice did not influence this outcome (pooled HR 0.87 [0.73; 1.04]; p = 0.14).
  
  
  CONCLUSIONS
  Operative mortality in ESRD patients is comparable between mechanical and tissue valve replacement. Major bleeding episodes are significantly higher after mechanical valve replacement but structural degeneration in tissue valves during the follow-up period is low. Based on the findings from this meta-analysis, we would recommend using tissue valves in patients with ESRD.
authors.affiliation: Department of Cardiovascular Surgery, Queen Alia Heart Institute, Amman, Jordan.
authors.forename: Salah E
authors.initials: SE
authors.lastname: Altarabsheh
authors.affiliation: Division of Cardiovascular Surgery, Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio.
authors.forename: Salil V
authors.initials: SV
authors.lastname: Deo
authors.affiliation: Division of Cardiology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Shannon M
authors.initials: SM
authors.lastname: Dunlay
authors.affiliation: Department of Cardiac Surgery, Al-Mouwasat Hospital, Al-Dammam, Kingdom of Saudi Arabia.
authors.forename: Yaqthan M
authors.initials: YM
authors.lastname: Obeidat
authors.affiliation: Mayo Clinic Libraries, Mayo Clinic, Rochester, Minnesota.
authors.forename: Patricia J
authors.initials: PJ
authors.lastname: Erwin
authors.affiliation: Department of Clinical Pharmacy, Jordan University of Science and Technology, Irbid, Jordan.
authors.forename: Abeer
authors.initials: A
authors.lastname: Rababa'h
authors.affiliation: Division of Nephrology, University Hospitals, Cleveland, Ohio.
authors.forename: Nagaraju
authors.initials: N
authors.lastname: Sarabhu
authors.affiliation: Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Suparna
authors.initials: S
authors.lastname: Navale
authors.affiliation: Division of Cardiovascular Surgery, Samsung Hospitals, Sungkyunkwang School of Medicine, Seoul, South Korea.
authors.forename: Yang Hyun
authors.initials: YH
authors.lastname: Cho
authors.affiliation: Department of Cardiothoracic Surgery, Louis Stokes Veterans Affairs, Cleveland, Ohio.
authors.forename: Harveen K
authors.initials: HK
authors.lastname: Lamba
authors.affiliation: Division of Cardiovascular Surgery, Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio.
authors.forename: Alan H
authors.initials: AH
authors.lastname: Markowitz
authors.affiliation: Division of Cardiovascular Surgery, Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio.
authors.forename: Soon J
authors.initials: SJ
authors.lastname: Park
mesh_terms: D001705:Bioprosthesis; D006349:Heart Valve Diseases / Q000150:complications / Q000601:surgery*; D006350:Heart Valve Prosthesis; D006351:Heart Valves / Q000637:transplantation*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications*; D011474:Prosthesis Design; D012189:Retrospective Studies