Impact of End-Stage Renal Disease on Outcomes in Mechanical Versus Bioprosthetic Valve Replacement.

BACKGROUND: Choosing between mechanical and bioprosthetic valves for aortic valve replacement (AVR) or mitral valve replacement (MVR) remains challenging, particularly for patients with end-stage renal disease (ESRD). Patients with ESRD have an increased risk of bleeding due to simultaneous anticoagulation therapy and accelerated valve calcification, which can complicate valve selection.

METHODS: In this nationwide retrospective cohort study, we used data from Taiwan's National Health Insurance Research Database. We included patients who underwent AVR or MVR from 2001 to 2020. Propensity score matching and inverse probability of treatment weighting were applied to mitigate confounding factors.

RESULTS: We included 16,649 patients: 9758 who underwent single AVR and 6891 who underwent single MVR. In patients with ESRD, bioprosthetic valves were associated with lower all-cause mortality than were mechanical valves. The optimal age cutoffs for patients with and without ESRD were 63 and 66 years for AVR, respectively, and 54 and 70 years for MVR, respectively. Patients with ESRD had higher rates of adverse outcomes, including major bleeding and redo valve operations. The lower age cutoff for MVR in patients with ESRD suggests earlier use of bioprosthetic valves may offer benefits in this population.

CONCLUSIONS: The presence of ESRD significantly influences whether mechanical or bioprosthetic valves are most appropriate, and treatment strategies should be individualized. Bioprosthetic valves may improve outcomes for patients with ESRD by reducing mortality and bleeding risk. However, further research is required to refine valve selection guidelines for this high-risk population.