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Prosthesis Choice in Dialysis Patients Undergoing Mitral Valve Replacement
Amit Iyengar1, Cindy Song2, Noah Weingarten1
1Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
The Annals of Thoracic Surgery
|May 28, 2023
Summary
Mitral valve replacement in dialysis patients has high early mortality. Prosthesis choice did not impact survival, but mechanical valves increased stroke risk, while bioprosthetic valves led to reintervention for failure.
Area of Science:
- Cardiology
- Nephrology
- Cardiac Surgery
Background:
- Dialysis patients have high comorbidity and limited life expectancy.
- Accelerated prosthetic valve degeneration is a concern in this population.
- Understanding prosthesis choice impact is crucial for optimizing outcomes.
Purpose of the Study:
- To examine the impact of mechanical versus bioprosthetic prosthesis choice on outcomes.
- To analyze mortality, valve failure, and reintervention rates in dialysis patients undergoing mitral valve replacement (MVR).
Main Methods:
- Retrospective review of adult patients undergoing MVR between 2002 and 2019.
- Inclusion criteria: documented renal failure and dialysis requirement.
- Primary outcomes: death, recurrent severe valve failure, or redo mitral operation.
Main Results:
- 177 dialysis patients underwent MVR; 66.7% received bioprosthetic valves, 33.3% mechanical.
- Mechanical valve recipients were younger and had less diabetes.
- No significant difference in 5-year mortality or reintervention rates; mechanical valves associated with higher stroke rates.
- High early mortality observed in both groups (<50% survival at 2 years).
Conclusions:
- Mitral valve replacement in dialysis patients is associated with significant morbidity and increased midterm mortality.
- Prosthesis choice requires careful consideration of individual patient life expectancy.
- Tailoring prosthesis selection to dialysis-dependent patients is essential.
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