Valve replacement outcomes in hemodialysis patients remain shaped by limited life expectancy and valve-related complications. In the Journal of Thoracic and Cardiovascular Surgery, a nationwide database analysis compared outcomes between bioprosthetic valves (BP) and mechanical valves (MP) in hemodialysis patients undergoing first-time valve replacement.

The study included 765 patients identified from a national health insurance database. A total of 421 patients received BP, and 344 received MP. Outcomes were compared after adjustment. Age-dependent subgroup analyses were performed. Median survival time was calculated. A competing risk analysis evaluated late clinical events.

Early outcomes and late mortality were comparable between BP and MP groups after adjustment. Redo aortic valve replacement occurred more frequently in the BP group. Rates were 1.3% per patient-year versus 0.3% per patient-year in the MP group (P = 0.002). Gastrointestinal bleeding occurred more often in the MP group. Rates were 7.0% per patient-year versus 4.8% per patient-year in the BP group (P = 0.010). Survival did not differ across age-based subgroups.

The estimated median survival was 6.6 years for patients younger than 50 years. It was 4.0 years for those aged 50 to 64 years. It was 2.1 years for patients aged 65 years or older. Competing risk analysis showed fewer valve durability-related events with MP use. The adjusted subdistribution hazard ratio was 0.45 (95% confidence interval, 0.25-0.80; P = 0.006). Major bleeding events were more frequent with MP use. The adjusted subdistribution hazard ratio was 1.46 (95% confidence interval, 1.13-1.89; P = 0.004).

These findings describe differences in valve durability-related events and bleeding risk in hemodialysis patients undergoing valve replacement.