Background: The aim of this study is to evaluate the outcomes of bioprosthetic versus mechanical valves in patients on dialysis. Methods: All patients who underwent aortic (AVR) or mitral valve replacement (MVR) at a single institution from 2011–2017 were reviewed. Primary stratification was bioprosthetic versus mechanical valves. The primary outcome was all-cause mortality. Secondary outcomes included hospital readmission, valve reoperation rates and bleeding events. Kaplan-Meier curves were generated and Cox proportional hazards regression models were used for risk-adjustment. Results: During the study period, 3,969 patients underwent AVR or MVR, of which 97 (2.4%) were on dialysis. In dialysis patients, unadjusted 30-day mortality was comparable between bioprosthetic (12.7%) versus mechanical (5.9%) valves (P=0.31). However, the bioprosthetic group had higher rates of 1-year (40.3% versus 15.2%; P=0.03) and 5-year mortality (67.9% versus 60.7%; P=0.02). Most patients were readmitted within 5 years with no differences between the groups (bioprosthetic 80.3% versus mechanical 100%; P=0.57). There were no valve reoperations in either group at 5 years. The 5-year readmission rate was higher in the mechanical cohort (10.5% versus 53.8%; P=0.05). Risk-adjusted analysis confirmed these findings, where mechanical valves were independently associated with reduced mortality at 1-year and 5-years. Conclusions: Despite the limited life expectancy of patients on dialysis, mechanical valves have an intermediate term mortality benefit compared to bioprosthetic valves. This comes at the expense of a higher rate of readmission for bleeding. Although valve choice should consider multiple factors, these data suggest that mechanical valve usage in dialysis patients is reasonable.
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机译：背景：本研究的目的是评估透析患者生物瓣膜与机械瓣膜的结局。方法：对2011-2017年在同一机构接受过主动脉（AVR）或二尖瓣置换术（MVR）的所有患者进行回顾。主要分层是生物瓣膜与机械瓣膜。主要结果是全因死亡率。次要结果包括住院再入院，瓣膜再手术率和出血事件。产生Kaplan-Meier曲线，并使用Cox比例风险回归模型进行风险调整。结果：在研究期间，有3969例患者接受了AVR或MVR，其中97例（2.4％）接受了透析。在透析患者中，未经调整的30天死亡率在生物人工瓣膜（12.7％）与机械瓣膜（5.9％）之间相当（P = 0.31）。然而，生物假体组的1年（40.3％比15.2％; P = 0.03）和5年死亡率（67.9％比60.7％; P = 0.02）更高。大多数患者在5年内重新入院，各组之间无差异（生物假体80.3％与机械假体100％; P = 0.57）。两组在5年时均未进行瓣膜再手术。机械队列的5年再入院率更高（10.5％对53.8％; P = 0.05）。风险调整后的分析证实了这些发现，其中机械瓣膜与1年和5年死亡率的降低独立相关。结论：尽管透析患者的预期寿命有限，但与生物瓣膜相比，机械瓣膜具有中期死亡率受益。这是以较高的出血再入院率为代价的。尽管选择瓣膜应考虑多种因素，但这些数据表明透析患者使用机械瓣膜是合理的。
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