Prosthesis Choice in Dialysis Patients Undergoing Mitral Valve Replacement

Amit Iyengar; Cindy Song; Noah Weingarten; David Rekhtman; David A Herbst; Max Shin; Mark R Helmers; Pavan Atluri

doi:10.1016/j.athoracsur.2023.05.015

Prosthesis Choice in Dialysis Patients Undergoing Mitral Valve Replacement

Ann Thorac Surg. 2023 Nov;116(5):963-970. doi: 10.1016/j.athoracsur.2023.05.015. Epub 2023 May 26.

Authors

Amit Iyengar¹, Cindy Song², Noah Weingarten¹, David Rekhtman², David A Herbst¹, Max Shin², Mark R Helmers¹, Pavan Atluri³

Affiliations

¹ Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
² Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
³ Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: pavan.atluri@pennmedicine.upenn.edu.

PMID: 37245789
DOI: 10.1016/j.athoracsur.2023.05.015

Abstract

Background: Patients with renal disease on dialysis have significant comorbidity limiting life expectancy; however, these patients may experience accelerated prosthetic valve degeneration. The purpose of this study was to examine the impact of prosthesis choice on outcomes in dialysis patients undergoing mitral valve replacement (MVR) at our high-volume academic center.

Methods: Adults undergoing MVR were retrospectively reviewed between January 2002 and November 2019. Patients were included if they had documented renal failure and dialysis requirements before presentation. Patients were stratified by mechanical vs bioprosthetic prosthesis. Death and recurrent severe valve failure (3+ or greater) or redo mitral operation were used as primary outcomes.

Results: There were 177 dialysis patients identified who underwent MVR. Of these, 118 (66.7%) received bioprosthetic valves, whereas 59 (33.3%) received mechanical valves. Those who received mechanical valves were younger (48 vs 61 years; P < .001) and had less diabetes (32% vs 51%; P = .019). Prevalence of endocarditis and atrial fibrillation was similar. Postoperative length of stay was not different between groups. Risk-adjusted hazard for 5-year mortality was similar between groups (P = .668). Early mortality was high, with both groups having <50% actuarial survival at 2 years. No differences were noted in rates of structural valve deterioration or reintervention. More stroke events were noted on follow-up in patients receiving mechanical valves (15% vs 6%; P = .041). Endocarditis was the leading reason for reintervention; 4 patients received repeated surgery for bioprosthetic valve failure.

Conclusions: MVR in dialysis patients carries significant morbidity and increased midterm mortality. Decreased life expectancy should be considered in the tailoring of prosthesis choice to dialysis-dependent patients.