Bioprosthetic versus mechanical prostheses for valve replacement in end-stage renal disease patients: Systematic review and metaanalysis

Kevin Phan, Dong Fang Zhao, Jessie J. Zhou, Aran Karagaratnam, Steven Phan, Tristan D. Yan

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Patients with end-stage renal disease (ESRD) indicated for dialysis are increasingly requiring cardiac valve surgery. The choice of bioprosthetic or mechanic valve prosthesis for such patients requires careful risk assessment. A systematic review and meta-analysis was performed to assess current evidence available. Methods: A comprehensive search from six electronic databases was performed from their inception to February 2015. Results from patients with ESRD undergoing cardiac surgery for bioprosthetic or mechanical valve replacement were identified. Results: Sixteen studies with 8,483 patients with ESRD undergoing cardiac valve replacement surgery were included. No evidence of publication bias was detected. Prior angioplasty by percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery was significantly higher in the bioprosthetic group compared to the mechanical group (16.0% vs. 12.0%, P=0.04); all other preoperative baseline patient characteristics were similar. There was no significant difference in 30-day mortality or allcause mortality between the two comparisons. Compared with the mechanical group, the frequency of bleeding (5.2% vs. 6.4%, P=0.04) and risk of thromboembolism (2.7% vs. 12.8%, P=0.02) were significantly lower in the bioprosthetic group. There were similar rates of reoperation and valve endocarditis. Conclusions: The present study demonstrated that patients with ESRD undergoing bioprosthetic or mechanical valve replacement had similar mid-long term survival. The bioprosthetic group had lower rates of bleeding and thromboembolism. Further studies are required to differentiate the impact of valve location. The presented results may be applicable for ESRD patients requiring prosthetic valve replacement.

LanguageEnglish
Pages769-777
Number of pages9
JournalJournal of Thoracic Disease
Volume8
Issue number5
DOIs
Publication statusPublished - 1 May 2016

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Chronic Kidney Failure
Prostheses and Implants
Thromboembolism
Heart Valves
Thoracic Surgery
Hemorrhage
Publication Bias
Mortality
Percutaneous Coronary Intervention
Endocarditis
Reoperation
Angioplasty
Coronary Artery Bypass
Meta-Analysis
Dialysis
Databases
Transplants
Survival

Keywords

  • Bioprosthesis
  • mechanical valve
  • aortic valve
  • mitral valve
  • valve replacement
  • dialysis
  • renal failure

Cite this

Phan, Kevin ; Zhao, Dong Fang ; Zhou, Jessie J. ; Karagaratnam, Aran ; Phan, Steven ; Yan, Tristan D. / Bioprosthetic versus mechanical prostheses for valve replacement in end-stage renal disease patients : Systematic review and metaanalysis. In: Journal of Thoracic Disease. 2016 ; Vol. 8, No. 5. pp. 769-777.
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abstract = "Background: Patients with end-stage renal disease (ESRD) indicated for dialysis are increasingly requiring cardiac valve surgery. The choice of bioprosthetic or mechanic valve prosthesis for such patients requires careful risk assessment. A systematic review and meta-analysis was performed to assess current evidence available. Methods: A comprehensive search from six electronic databases was performed from their inception to February 2015. Results from patients with ESRD undergoing cardiac surgery for bioprosthetic or mechanical valve replacement were identified. Results: Sixteen studies with 8,483 patients with ESRD undergoing cardiac valve replacement surgery were included. No evidence of publication bias was detected. Prior angioplasty by percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery was significantly higher in the bioprosthetic group compared to the mechanical group (16.0{\%} vs. 12.0{\%}, P=0.04); all other preoperative baseline patient characteristics were similar. There was no significant difference in 30-day mortality or allcause mortality between the two comparisons. Compared with the mechanical group, the frequency of bleeding (5.2{\%} vs. 6.4{\%}, P=0.04) and risk of thromboembolism (2.7{\%} vs. 12.8{\%}, P=0.02) were significantly lower in the bioprosthetic group. There were similar rates of reoperation and valve endocarditis. Conclusions: The present study demonstrated that patients with ESRD undergoing bioprosthetic or mechanical valve replacement had similar mid-long term survival. The bioprosthetic group had lower rates of bleeding and thromboembolism. Further studies are required to differentiate the impact of valve location. The presented results may be applicable for ESRD patients requiring prosthetic valve replacement.",
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Bioprosthetic versus mechanical prostheses for valve replacement in end-stage renal disease patients : Systematic review and metaanalysis. / Phan, Kevin; Zhao, Dong Fang; Zhou, Jessie J.; Karagaratnam, Aran; Phan, Steven; Yan, Tristan D.

In: Journal of Thoracic Disease, Vol. 8, No. 5, 01.05.2016, p. 769-777.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Bioprosthetic versus mechanical prostheses for valve replacement in end-stage renal disease patients

T2 - Journal of Thoracic Disease

AU - Phan, Kevin

AU - Zhao, Dong Fang

AU - Zhou, Jessie J.

AU - Karagaratnam, Aran

AU - Phan, Steven

AU - Yan, Tristan D.

PY - 2016/5/1

Y1 - 2016/5/1

N2 - Background: Patients with end-stage renal disease (ESRD) indicated for dialysis are increasingly requiring cardiac valve surgery. The choice of bioprosthetic or mechanic valve prosthesis for such patients requires careful risk assessment. A systematic review and meta-analysis was performed to assess current evidence available. Methods: A comprehensive search from six electronic databases was performed from their inception to February 2015. Results from patients with ESRD undergoing cardiac surgery for bioprosthetic or mechanical valve replacement were identified. Results: Sixteen studies with 8,483 patients with ESRD undergoing cardiac valve replacement surgery were included. No evidence of publication bias was detected. Prior angioplasty by percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery was significantly higher in the bioprosthetic group compared to the mechanical group (16.0% vs. 12.0%, P=0.04); all other preoperative baseline patient characteristics were similar. There was no significant difference in 30-day mortality or allcause mortality between the two comparisons. Compared with the mechanical group, the frequency of bleeding (5.2% vs. 6.4%, P=0.04) and risk of thromboembolism (2.7% vs. 12.8%, P=0.02) were significantly lower in the bioprosthetic group. There were similar rates of reoperation and valve endocarditis. Conclusions: The present study demonstrated that patients with ESRD undergoing bioprosthetic or mechanical valve replacement had similar mid-long term survival. The bioprosthetic group had lower rates of bleeding and thromboembolism. Further studies are required to differentiate the impact of valve location. The presented results may be applicable for ESRD patients requiring prosthetic valve replacement.

AB - Background: Patients with end-stage renal disease (ESRD) indicated for dialysis are increasingly requiring cardiac valve surgery. The choice of bioprosthetic or mechanic valve prosthesis for such patients requires careful risk assessment. A systematic review and meta-analysis was performed to assess current evidence available. Methods: A comprehensive search from six electronic databases was performed from their inception to February 2015. Results from patients with ESRD undergoing cardiac surgery for bioprosthetic or mechanical valve replacement were identified. Results: Sixteen studies with 8,483 patients with ESRD undergoing cardiac valve replacement surgery were included. No evidence of publication bias was detected. Prior angioplasty by percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery was significantly higher in the bioprosthetic group compared to the mechanical group (16.0% vs. 12.0%, P=0.04); all other preoperative baseline patient characteristics were similar. There was no significant difference in 30-day mortality or allcause mortality between the two comparisons. Compared with the mechanical group, the frequency of bleeding (5.2% vs. 6.4%, P=0.04) and risk of thromboembolism (2.7% vs. 12.8%, P=0.02) were significantly lower in the bioprosthetic group. There were similar rates of reoperation and valve endocarditis. Conclusions: The present study demonstrated that patients with ESRD undergoing bioprosthetic or mechanical valve replacement had similar mid-long term survival. The bioprosthetic group had lower rates of bleeding and thromboembolism. Further studies are required to differentiate the impact of valve location. The presented results may be applicable for ESRD patients requiring prosthetic valve replacement.

KW - Bioprosthesis

KW - mechanical valve

KW - aortic valve

KW - mitral valve

KW - valve replacement

KW - dialysis

KW - renal failure

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U2 - 10.21037/jtd.2016.02.74

DO - 10.21037/jtd.2016.02.74

M3 - Article

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EP - 777

JO - Journal of Thoracic Disease

JF - Journal of Thoracic Disease

SN - 2072-1439

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