Cardiac valve replacement in patients on dialysis: Influence of prosthesison survival

Background. Mechanical valves have been recommended for patients on dialysi s because of purported accelerated bioprosthesis degeneration. This study w as undertaken to determine time-related outcomes in dialysis patients requi ring cardiac valve replacement. Methods. From 1986 to 1998, 42 patients on chronic preoperative dialysis un derwent valve replacement; 17 received mechanical valves and 25 received bi oprostheses. Age was similar in both groups: 54 +/- 18.5 years (mechanical) and 59 +/- 15.5 years (bioprosthetic, p = 0.4). Sites of valve replacement were aortic (27), mitral (11), and aortic and mitral (4). Follow-up was 10 0% complete. Results. Survival at 3 and 5 years was 50% and 33% after mechanical valve r eplacement, and 36% and 27% after bioprosthetic valve replacement (p = 0.3) . Four patients with bioprostheses required reoperation: 3 for allograft en docarditis and 1 at 10 months for mitral bioprosthesis degeneration. One pa tient who received a mechanical valve required reoperation. Conclusions. Prosthetic valve-related complications in patients on dialysis were similar for both mechanical and bioprosthetic valves. Because of the limited life expectancy of patients on dialysis, bioprosthesis degeneration will be uncommon. Therefore, surgeons should not hesitate to implant biopr osthetic valves in these patients. (C) 2000 by The Society of Thoracic Surg eons.