TY - JOUR
T1 - Mechanical vs Bioprosthetic Aortic Valve Replacement in Patients on Dialysis
T2 - Long-term Outcomes
AU - Matsuura, Kaoru
AU - Yamamoto, Hiroyuki
AU - Miyata, Hiroaki
AU - Matsumiya, Goro
AU - Motomura, Noboru
N1 - Funding Information:
This study was supported by a research grant from the Japanese Society of Cardiovascular Surgery . Kaoru Matsuura and Goro Matsumiya report that the affiliated department received scholarship funds from the Otsuka Pharmaceutical Co Ltd , Century Medical Inc , Medtronic Japan Co Ltd , Terumo Corp , and Japan Lifeline Co Ltd . Kaoru Matsuura is a clinical proctor for Edwards Lifesciences. The affiliation of Hiroyuki Yamamoto and Hiroaki Miyata is a social collaboration department supported by grants from the National Clinical Database , Johnson & Johnson KK, and Nipro Co .
Funding Information:
The authors would like to express their appreciation to the institutions that participated in our study, especially their willingness to complete the additional questionnaires. This study was supported by a research grant from the Japanese Society of Cardiovascular Surgery. Kaoru Matsuura and Goro Matsumiya report that the affiliated department received scholarship funds from the Otsuka Pharmaceutical Co Ltd, Century Medical Inc, Medtronic Japan Co Ltd, Terumo Corp, and Japan Lifeline Co Ltd. Kaoru Matsuura is a clinical proctor for Edwards Lifesciences. The affiliation of Hiroyuki Yamamoto and Hiroaki Miyata is a social collaboration department supported by grants from the National Clinical Database, Johnson & Johnson KK, and Nipro Co. The authors have no conflicts of interest to disclose.
Publisher Copyright:
© 2023 The Society of Thoracic Surgeons
PY - 2023
Y1 - 2023
N2 - Background: Using the Japan National Clinical Database and additional data, this study is an analysis of long-term survival of dialysis-dependent patients who underwent aortic valve replacement (AVR). Methods: Dialysis-dependent patients who underwent de novo AVR between 2010 and 2012 and who were registered in the database were included. Concomitant aortic surgery and transcatheter aortic valve replacement were excluded. Additional data on the underlying kidney disease, the duration of dialysis, and clinical outcomes were registered between October 29, 2019, and August 30, 2020. The primary outcome was all-cause mortality. The secondary outcomes were cerebral infarction, cerebral bleeding, gastrointestinal bleeding, and prosthetic valve failure. Results: After propensity score matching, 1016 cases (508 each in the bioprosthetic and mechanical valve groups) were matched. The median follow-up period was 3.29 years (interquartile range [IQR], 0.59 years, 6.25 years). The median survival time was 5.38 years (IQR, 1.20 and 9.26 years) in the mechanical valve group and 4.98 years (IQR, 1.69 and 9.62 years) in the bioprosthetic valve group. The Cox regression model showed no significant difference in long-term survival between the groups (mechanical valve: hazard ratio [HR], 0.895; 95% CI, 0.719-1.113; P = .318). The incidences of cerebral infarction and prosthetic valve failure requiring admission were similar between the groups. Cerebral bleeding (HR, 2.143; 95% CI, 1.125-4.080; P = .002) and gastrointestinal bleeding (HR, 2.071; 95% CI, 1.243-3.451; P = .0005) were more frequent in the mechanical valve group. Conclusions: Long-term survival of dialysis-dependent patients was similar regardless of whether mechanical valves or bioprosthetic valves were implanted. The incidences of cerebral and gastrointestinal bleeding were 2-fold higher in the mechanical valve group.
AB - Background: Using the Japan National Clinical Database and additional data, this study is an analysis of long-term survival of dialysis-dependent patients who underwent aortic valve replacement (AVR). Methods: Dialysis-dependent patients who underwent de novo AVR between 2010 and 2012 and who were registered in the database were included. Concomitant aortic surgery and transcatheter aortic valve replacement were excluded. Additional data on the underlying kidney disease, the duration of dialysis, and clinical outcomes were registered between October 29, 2019, and August 30, 2020. The primary outcome was all-cause mortality. The secondary outcomes were cerebral infarction, cerebral bleeding, gastrointestinal bleeding, and prosthetic valve failure. Results: After propensity score matching, 1016 cases (508 each in the bioprosthetic and mechanical valve groups) were matched. The median follow-up period was 3.29 years (interquartile range [IQR], 0.59 years, 6.25 years). The median survival time was 5.38 years (IQR, 1.20 and 9.26 years) in the mechanical valve group and 4.98 years (IQR, 1.69 and 9.62 years) in the bioprosthetic valve group. The Cox regression model showed no significant difference in long-term survival between the groups (mechanical valve: hazard ratio [HR], 0.895; 95% CI, 0.719-1.113; P = .318). The incidences of cerebral infarction and prosthetic valve failure requiring admission were similar between the groups. Cerebral bleeding (HR, 2.143; 95% CI, 1.125-4.080; P = .002) and gastrointestinal bleeding (HR, 2.071; 95% CI, 1.243-3.451; P = .0005) were more frequent in the mechanical valve group. Conclusions: Long-term survival of dialysis-dependent patients was similar regardless of whether mechanical valves or bioprosthetic valves were implanted. The incidences of cerebral and gastrointestinal bleeding were 2-fold higher in the mechanical valve group.
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U2 - 10.1016/j.athoracsur.2022.12.037
DO - 10.1016/j.athoracsur.2022.12.037
M3 - Article
C2 - 36634834
AN - SCOPUS:85147555087
SN - 0003-4975
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
ER -