Document Detail

Should we use mechanical valves in patients with end-stage renal disease?
MedLine Citation:
PMID:  22552798     Owner:  NLM     Status:  MEDLINE    
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether a mechanical or bioprosthetic valve is superior for immediate and long-term survival in patients with end-stage renal disease (ESRD) undergoing a valve replacement. Altogether more than 150 papers were found using the reported search; of which, eight represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. There were no randomized controlled trials addressing the question. There was one systematic review and meta-analysis. All the other evidence was in the form of retrospective studies. The papers show that there is no significant difference in the results and survival between patients receiving a mechanical and those receiving a bioprosthetic valve. This was seen in the meta-analysis as well as the larger series of patients who underwent valve replacement. Bleeding complications were more common with mechanical valves. We conclude that the choice of valve for patients with ESRD should be determined by age, level of activity and patient choice. Due to the limited life expectancy of these patients, bioprosthetic valves should be considered, especially since there is no evidence of early degeneration of tissue valves in this subgroup of patients.
Vasudev B Pai; Cheh Kuan Tai; Kunal Bhakri; Shyam Kolvekar
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Publication Detail:
Type:  Journal Article; Review     Date:  2012-05-02
Journal Detail:
Title:  Interactive cardiovascular and thoracic surgery     Volume:  15     ISSN:  1569-9285     ISO Abbreviation:  Interact Cardiovasc Thorac Surg     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-07-17     Completed Date:  2012-11-19     Revised Date:  2013-08-14    
Medline Journal Info:
Nlm Unique ID:  101158399     Medline TA:  Interact Cardiovasc Thorac Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  240-3     Citation Subset:  IM    
Department of Cardiothoracic Surgery, Heart Hospital , University College London Hospital, London, UK.
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MeSH Terms
Evidence-Based Medicine
Heart Valve Diseases / complications,  mortality,  surgery*
Heart Valve Prosthesis*
Heart Valve Prosthesis Implantation / adverse effects,  instrumentation*,  mortality
Kidney Failure, Chronic / complications*,  mortality
Middle Aged
Patient Selection
Prosthesis Design
Risk Assessment
Risk Factors
Treatment Outcome
Comment In:
Interact Cardiovasc Thorac Surg. 2012 Aug;15(2):243   [PMID:  22802509 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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