Long term survival of dialysis patients independent of type of prosthetic valve substitute

Introduction: Mechanical valves are often used in renal dialysis patients due to presumed rapid degeneration of tissue valves. The purpose of this study was to compare the results of mechanical and tissue valves placed in renal dialysis patients. Materials: A computer database, phone interviews and patient charts were reviewed for followup data. Statistic analysis was performed by SPSS 13.0. Results: 56 patients underwent valve replacement between 1997 and 2006. 33 patients received 39 mechanical valves (26 aortic, 12 mitral and 1 tricuspid). 23 patients received 26 tissue valves (18 aortic, 7 mitral and 1 pulmonary). Patients in the mechanical group had a tendentially lower logistic Euroscore (16.1±17.56% vs. 23.96±19.97%; ns). Patient followup for the mechanical and tissue groups was 53.83 and 33.51 patient years respectively. 30 day mortality was 21.2% (7/33) and 21.7% (5/23) for mechanical and tissue valve groups respectively (ns, p>0.05). Overall mortality (operative and late) was 45.4% for the mechanical group (15/33) and 43.8% (10/23) for the tissue group (ns p>0.05). Structural valve degeneration requiring reoperation occured in 4.34% (1/23) of the tissue valves in the followup period. Kaplan-Meier freedom from thrombembolism (mech/bio: 1/0), haemorrhage (1/1), valve related mortality (4/4) and valve related mortality or morbidity (17/12) at 3 years demonstrated no significant difference (ns p>0.05). Conclusions: Dialysis patients had poor survival, irrespective of age; structural valve deterioration was negligible. There was no long term superiority of mechanical prostheses over biological prostheses in terms of freedom from valve related complications. Bioprostheses should be considered for treatment of valvular disease in end stage renal disease patients.