Outcomes of Surgical Mitral and Aortic Valve Replacements Among Kidney Transplant Candidates: Implications for Valve Selection
Background Limited literature exists that evaluated outcomes of kidney transplant–eligible patients who are having dialysis and who are undergoing valve replacement. Our main objective in this study was to compare mortality, reoperation, and bleeding episodes between bioprosthetic and mechanical val...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2021-03-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.120.018971 |
| _version_ | 1818315299275931648 |
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| author | David K. Ngendahimana Salil V. Deo Varun Sundaram Krista L. Lentine Charles A. Herzog Laith Al Dahabreh Titte R. Srinivas Kenneth D. Chavin Nagaraju Sarabu |
| author_facet | David K. Ngendahimana Salil V. Deo Varun Sundaram Krista L. Lentine Charles A. Herzog Laith Al Dahabreh Titte R. Srinivas Kenneth D. Chavin Nagaraju Sarabu |
| author_sort | David K. Ngendahimana |
| collection | DOAJ |
| description | Background Limited literature exists that evaluated outcomes of kidney transplant–eligible patients who are having dialysis and who are undergoing valve replacement. Our main objective in this study was to compare mortality, reoperation, and bleeding episodes between bioprosthetic and mechanical valve procedures among kidney transplant–eligible patients who are having dialysis. Methods and Results We studied 887 and 1925 dialysis patients from the United States Renal Data System, who underwent mitral valve replacement and aortic valve replacement (AVR) after being waitlisted for a kidney transplant (2000–2015), respectively. Time to death, time to reoperation, and time to bleeding requiring hospitalizations were compared separately for AVR and mitral valve replacement. Kaplan–Meier survival curves, Cox proportional hazards model for time to death, accelerated time to event model for time to reoperation, and counting process model for time to recurrent bleeding were used. There were no differences in mortality (hazard ratio [HR], 0.92; 95% CI, 0.77–1.09) or risk of reoperation or risk of significant bleeding events between bioprosthetic and mechanical mitral valve replacement. However, mechanical AVR was associated with a modestly significant less hazard of death (HR, 0.83; 95% CI, 0.74–0.94) compared with bioprosthetic AVR. There were no differences in time to reoperation, or time to significant bleeding events between bioprosthetic and mechanical AVR. Conclusions For kidney transplant waitlisted patients who are on dialysis and who are undergoing surgical valve replacement, bioprosthetic and mechanical valves have comparable survival, reoperation rates, and bleeding episodes requiring hospitalizations at both mitral and aortic locations. These findings emphasize that an individualized informed decision is recommended when choosing the type of valve for this special group of patients having dialysis. |
| first_indexed | 2024-12-13T09:03:20Z |
| format | Article |
| id | doaj.art-785231fcb5a449089e611f10c629d319 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-13T09:03:20Z |
| publishDate | 2021-03-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-785231fcb5a449089e611f10c629d3192022-12-21T23:53:07ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802021-03-0110510.1161/JAHA.120.018971Outcomes of Surgical Mitral and Aortic Valve Replacements Among Kidney Transplant Candidates: Implications for Valve SelectionDavid K. Ngendahimana0Salil V. Deo1Varun Sundaram2Krista L. Lentine3Charles A. Herzog4Laith Al Dahabreh5Titte R. Srinivas6Kenneth D. Chavin7Nagaraju Sarabu8National Center for PTSD Veterans Health Administration Menlo Park CADivision of Cardiac Surgery Louis Stokes Veterans Affairs Medical Center Cleveland OHDivision of Cardiology Department of Medicine University Hospitals Cleveland Medical Center Cleveland OHCenter for Abdominal Transplantation Saint Louis University St. Louis MODivision of Cardiology Department of Internal Medicine Hennepin Healthcare and University of Minnesota Minneapolis MNTransplant Institute University Hospitals Cleveland Medical Center Cleveland OHTransplant Institute University Hospitals Cleveland Medical Center Cleveland OHTransplant Institute University Hospitals Cleveland Medical Center Cleveland OHTransplant Institute University Hospitals Cleveland Medical Center Cleveland OHBackground Limited literature exists that evaluated outcomes of kidney transplant–eligible patients who are having dialysis and who are undergoing valve replacement. Our main objective in this study was to compare mortality, reoperation, and bleeding episodes between bioprosthetic and mechanical valve procedures among kidney transplant–eligible patients who are having dialysis. Methods and Results We studied 887 and 1925 dialysis patients from the United States Renal Data System, who underwent mitral valve replacement and aortic valve replacement (AVR) after being waitlisted for a kidney transplant (2000–2015), respectively. Time to death, time to reoperation, and time to bleeding requiring hospitalizations were compared separately for AVR and mitral valve replacement. Kaplan–Meier survival curves, Cox proportional hazards model for time to death, accelerated time to event model for time to reoperation, and counting process model for time to recurrent bleeding were used. There were no differences in mortality (hazard ratio [HR], 0.92; 95% CI, 0.77–1.09) or risk of reoperation or risk of significant bleeding events between bioprosthetic and mechanical mitral valve replacement. However, mechanical AVR was associated with a modestly significant less hazard of death (HR, 0.83; 95% CI, 0.74–0.94) compared with bioprosthetic AVR. There were no differences in time to reoperation, or time to significant bleeding events between bioprosthetic and mechanical AVR. Conclusions For kidney transplant waitlisted patients who are on dialysis and who are undergoing surgical valve replacement, bioprosthetic and mechanical valves have comparable survival, reoperation rates, and bleeding episodes requiring hospitalizations at both mitral and aortic locations. These findings emphasize that an individualized informed decision is recommended when choosing the type of valve for this special group of patients having dialysis.https://www.ahajournals.org/doi/10.1161/JAHA.120.018971end‐stage renal diseasekidney transplantsurvivalUnited States Renal Data Systemvalve replacement |
| spellingShingle | David K. Ngendahimana Salil V. Deo Varun Sundaram Krista L. Lentine Charles A. Herzog Laith Al Dahabreh Titte R. Srinivas Kenneth D. Chavin Nagaraju Sarabu Outcomes of Surgical Mitral and Aortic Valve Replacements Among Kidney Transplant Candidates: Implications for Valve Selection Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease end‐stage renal disease kidney transplant survival United States Renal Data System valve replacement |
| title | Outcomes of Surgical Mitral and Aortic Valve Replacements Among Kidney Transplant Candidates: Implications for Valve Selection |
| title_full | Outcomes of Surgical Mitral and Aortic Valve Replacements Among Kidney Transplant Candidates: Implications for Valve Selection |
| title_fullStr | Outcomes of Surgical Mitral and Aortic Valve Replacements Among Kidney Transplant Candidates: Implications for Valve Selection |
| title_full_unstemmed | Outcomes of Surgical Mitral and Aortic Valve Replacements Among Kidney Transplant Candidates: Implications for Valve Selection |
| title_short | Outcomes of Surgical Mitral and Aortic Valve Replacements Among Kidney Transplant Candidates: Implications for Valve Selection |
| title_sort | outcomes of surgical mitral and aortic valve replacements among kidney transplant candidates implications for valve selection |
| topic | end‐stage renal disease kidney transplant survival United States Renal Data System valve replacement |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.120.018971 |
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