RESULTS OF VALVE-REPLACEMENT WITH MECHANICAL AND BIOLOGICAL PROSTHESES IN CHRONIC RENAL DIALYSIS PATIENTS

Background. Whether biological or mechanical valves should be used in patients on chronic dialysis therapy remains to be clearly defined. Me thods. A retrospective review was performed on 19 consecutive patients from our institution with end-stage renal disease on chronic peritone al or hemodialysis undergoing aortic (n = 12), mitral n = 5), or aorti c-mitral (n = 2) valve replacement. Results. The 9 biological and 10 m echanical valve patients had similar ages (56.5 versus 56.6 years) and cardiovascular risk factors. The overall estimated Kaplan-Meier survi val was 60% +/- 12% at 12 months and 42% +/- 14% at 60 months. Mechani cal valve patients had a significantly higher rate of postoperative ce rebrovascular accidents or bleeding complications (10/10 versus 0/9; X -2 17.0; p < 0.001). No subsequent reoperations were required for biol ogical valve failure at a mean follow-up of 32 +/- 53 months. Conclusi ons. These results demonstrate that in patients with end-stage renal d isease, use of mechanical valves is associated with significant risk o f complications, whereas biological valve failure from prosthetic dysf unction is unusual. Overall survival is poor in both groups of patient s. Therefore, preference should be given to biological valve instead o f mechanical valve prostheses in patients on chronic renal dialysis. ( C) 1997 by The Society of Thoracic Surgeons.