Long-Term Outcomes of Bioprosthetic or Mechanical Valve Replacement in End-Stage Renal Disease: A Nationwide Population-Based Retrospective Study
Background: Valve replacement is associated with worse outcomes in individuals who have end-stage renal disease (ESRD) and require a long-term renal replacement therapy. Prosthetic valve selection in patients with ESRD has remained controversial.Objective: We aimed to investigate long-term outcomes...
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| Format: | Article |
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Frontiers Media S.A.
2021-12-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2021.745370/full |
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| author | Guan-Yi Li Yun-Yu Chen Yun-Yu Chen Fa-Po Chung Fa-Po Chung Kuo-Liong Chien Chiao-Po Hsu Chiao-Po Hsu Yenn-Jiang Lin Yenn-Jiang Lin |
| author_facet | Guan-Yi Li Yun-Yu Chen Yun-Yu Chen Fa-Po Chung Fa-Po Chung Kuo-Liong Chien Chiao-Po Hsu Chiao-Po Hsu Yenn-Jiang Lin Yenn-Jiang Lin |
| author_sort | Guan-Yi Li |
| collection | DOAJ |
| description | Background: Valve replacement is associated with worse outcomes in individuals who have end-stage renal disease (ESRD) and require a long-term renal replacement therapy. Prosthetic valve selection in patients with ESRD has remained controversial.Objective: We aimed to investigate long-term outcomes of mechanical and bioprosthetic valve replacement in individuals with ESRD.Methods: We conducted a population-based retrospective cohort study using data obtained from the Taiwan National Health Insurance Research Database. In total, 10,202 patients, including 912 ESRD and 9,290 non-ESRD patients, were selected after a 1:1 propensity-score matching based on the type of prosthetic valve used. The long-term mortality outcomes were then analyzed.Results: During a median follow-up period of 59.6 months, the Kaplan–Meier survival analysis revealed that ESRD patients who underwent mechanical valve replacement had higher rates of all-cause mortality and CV deaths than those who underwent bioprosthetic valve replacement (Log-rank test, p = 0.03 and 0.02, respectively). Multivariable regression analyses demonstrated that ESRD patients who underwent bioprosthetic valve replacement had lower rates of all-cause mortality (p < 0.001, hazard ratio: 0.88, 95% confidence interval: 0.82–0.93) and cardiovascular (CV) death (p < 0.001, hazard ratio: 0.83, 95% confidence interval: 0.76–0.90) than those who had mechanical valve replacement.Conclusion: Bioprosthetic valve replacement is significantly associated with lower rates of all-cause mortality and CV death in the ESRD population. |
| first_indexed | 2024-12-13T21:17:14Z |
| format | Article |
| id | doaj.art-fa52380d6c384ec2be5886cec25113fc |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-12-13T21:17:14Z |
| publishDate | 2021-12-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-fa52380d6c384ec2be5886cec25113fc2022-12-21T23:31:13ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2021-12-01810.3389/fcvm.2021.745370745370Long-Term Outcomes of Bioprosthetic or Mechanical Valve Replacement in End-Stage Renal Disease: A Nationwide Population-Based Retrospective StudyGuan-Yi Li0Yun-Yu Chen1Yun-Yu Chen2Fa-Po Chung3Fa-Po Chung4Kuo-Liong Chien5Chiao-Po Hsu6Chiao-Po Hsu7Yenn-Jiang Lin8Yenn-Jiang Lin9Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, TaiwanDivision of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, TaiwanInstitute of Epidemiology and Preventive Medicine College of Public Health, National Taiwan University, Taipei, TaiwanDivision of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, TaiwanCardiovascular Research Center, Institute of Clinical Medicine, National Yang-Ming University, Taipei, TaiwanInstitute of Epidemiology and Preventive Medicine College of Public Health, National Taiwan University, Taipei, TaiwanCardiovascular Research Center, Institute of Clinical Medicine, National Yang-Ming University, Taipei, TaiwanDivision of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, TaiwanDivision of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, TaiwanCardiovascular Research Center, Institute of Clinical Medicine, National Yang-Ming University, Taipei, TaiwanBackground: Valve replacement is associated with worse outcomes in individuals who have end-stage renal disease (ESRD) and require a long-term renal replacement therapy. Prosthetic valve selection in patients with ESRD has remained controversial.Objective: We aimed to investigate long-term outcomes of mechanical and bioprosthetic valve replacement in individuals with ESRD.Methods: We conducted a population-based retrospective cohort study using data obtained from the Taiwan National Health Insurance Research Database. In total, 10,202 patients, including 912 ESRD and 9,290 non-ESRD patients, were selected after a 1:1 propensity-score matching based on the type of prosthetic valve used. The long-term mortality outcomes were then analyzed.Results: During a median follow-up period of 59.6 months, the Kaplan–Meier survival analysis revealed that ESRD patients who underwent mechanical valve replacement had higher rates of all-cause mortality and CV deaths than those who underwent bioprosthetic valve replacement (Log-rank test, p = 0.03 and 0.02, respectively). Multivariable regression analyses demonstrated that ESRD patients who underwent bioprosthetic valve replacement had lower rates of all-cause mortality (p < 0.001, hazard ratio: 0.88, 95% confidence interval: 0.82–0.93) and cardiovascular (CV) death (p < 0.001, hazard ratio: 0.83, 95% confidence interval: 0.76–0.90) than those who had mechanical valve replacement.Conclusion: Bioprosthetic valve replacement is significantly associated with lower rates of all-cause mortality and CV death in the ESRD population.https://www.frontiersin.org/articles/10.3389/fcvm.2021.745370/fullbioprosthetic valvecardiovascular eventend-stage renal diseasevalve replacementmechanical valvemortality |
| spellingShingle | Guan-Yi Li Yun-Yu Chen Yun-Yu Chen Fa-Po Chung Fa-Po Chung Kuo-Liong Chien Chiao-Po Hsu Chiao-Po Hsu Yenn-Jiang Lin Yenn-Jiang Lin Long-Term Outcomes of Bioprosthetic or Mechanical Valve Replacement in End-Stage Renal Disease: A Nationwide Population-Based Retrospective Study Frontiers in Cardiovascular Medicine bioprosthetic valve cardiovascular event end-stage renal disease valve replacement mechanical valve mortality |
| title | Long-Term Outcomes of Bioprosthetic or Mechanical Valve Replacement in End-Stage Renal Disease: A Nationwide Population-Based Retrospective Study |
| title_full | Long-Term Outcomes of Bioprosthetic or Mechanical Valve Replacement in End-Stage Renal Disease: A Nationwide Population-Based Retrospective Study |
| title_fullStr | Long-Term Outcomes of Bioprosthetic or Mechanical Valve Replacement in End-Stage Renal Disease: A Nationwide Population-Based Retrospective Study |
| title_full_unstemmed | Long-Term Outcomes of Bioprosthetic or Mechanical Valve Replacement in End-Stage Renal Disease: A Nationwide Population-Based Retrospective Study |
| title_short | Long-Term Outcomes of Bioprosthetic or Mechanical Valve Replacement in End-Stage Renal Disease: A Nationwide Population-Based Retrospective Study |
| title_sort | long term outcomes of bioprosthetic or mechanical valve replacement in end stage renal disease a nationwide population based retrospective study |
| topic | bioprosthetic valve cardiovascular event end-stage renal disease valve replacement mechanical valve mortality |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2021.745370/full |
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