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Long-term survival of dialysis patients in the United States with prosthetic heart valves: should ACC/AHA practice
Charles A Herzog1, Jennie Z Ma, Allan J Collins
1Cardiovascular Special Studies Center, US Renal Data System, Department of Internal Medicine, Division of Cardiology, University of Minnesota, Minneapolis 55415, USA. herzo003@umn.edu
Circulation
|March 20, 2002
Summary
Long-term survival for dialysis patients undergoing heart valve replacement shows no significant difference between tissue and nontissue prosthetic valves. Current guidelines against bioprosthetic valves in these patients should be reconsidered.
Area of Science:
- Cardiovascular Surgery
- Nephrology
- Biomaterials Science
Background:
- Limited data exist on long-term survival for dialysis patients post-cardiac valve surgery.
- Current guidelines discourage bioprosthetic (tissue) valves for hemodialysis patients.
Purpose of the Study:
- To evaluate the long-term survival outcomes of dialysis patients after cardiac valve replacement.
- To compare survival rates between tissue and nontissue prosthetic valves in this population.
Main Methods:
- Retrospective analysis of 5858 dialysis patients undergoing valve surgery (1978-1998) from the US Renal Data System.
- Life-table method for long-term survival estimation.
- Cox proportional hazards model to assess demographic and comorbidity impacts.
Main Results:
- In-hospital mortality was 20.7%.
- No significant difference in survival was observed between tissue and nontissue prosthetic valves.
- Tissue valve use was not predictive of death (RR 0.98; 95% CI 0.90 to 1.07).
Conclusions:
- Survival outcomes for dialysis patients are similar regardless of prosthetic valve type (tissue vs. nontissue).
- Existing practice guidelines recommending against bioprosthetic valves in hemodialysis patients should be rescinded.
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