Impact of valve position and prosthesis type on outcomes of valve replacement in end-stage renal disease patients with infective endocarditis.

OBJECTIVE

End-stage renal disease patients with infective endocarditis face high operative risk and poor survival. We sought to compare outcomes of mechanical versus bioprosthetic valve replacement in end-stage renal disease infective endocarditis, stratified by valve position.

METHODS

Consecutive end-stage renal disease patients with acute infective endocarditis (2015-2020) in the US Renal Data System who underwent valve replacement were included and stratified by valve position and prosthesis type. Outcomes included mortality, reinfection, reoperation, and stroke. Mortality, reinfection, and stroke were assessed with cumulative incidence functions using transplant and death as competing risks, respectively. Inverse probability of treatment weighting was used for covariate balance, and cubic splines modeled age-prosthesis interactions.

RESULTS

Of 1562 patients, 595 underwent aortic valve replacement, 685 underwent mitral valve replacement, 238 underwent aortic valve replacement + mitral valve replacement, and 44 underwent tricuspid valve replacement. Bioprosthetic valves were used in 73.4%. Operative mortality was 14.5% overall, lowest in aortic valve replacement (10.8%) and highest in aortic valve replacement + mitral valve replacement (23.5%; P < .001). Five-year mortality was 73.5% for mechanical and 76.0% for bioprosthetic valves, with no significant differences by valve type within any position. Reinfection occurred in 17.6% and did not differ by prosthesis. Reoperation was uncommon but higher in bioprosthetic mitral valve replacement (P = .023). Stroke was infrequent and did not significantly differ between valve types across any position.

CONCLUSIONS

Mortality for end-stage renal disease patients undergoing valve replacement for infective endocarditis is high, with outcomes varying by valve position. Prosthesis type did not consistently affect survival, reinfection, or stroke. These findings highlight the limited impact of prosthesis type and emphasize the importance of broader perioperative and systemic management strategies.