Mechanical versus bioprosthetic valves in chronic dialysis: a systematic review and meta-analysis
Kevin Kim, Emilie P. Belley‐Côté, Saurabh Gupta, Arjun Pandey, Ali Alsagheir, Ahmad Makhdoum, G. McClure, Brooke Newsome, Sophie Gao, Matthias Bossard, Tetsuya Isayama, Yasuhisa Ikuta, Michael Walsh, Amit X. Garg, Gordon Guyatt, Richard Whitlock
Abstract
BACKGROUND: Many patients with end-stage kidney disease (ESKD) have valvular heart disease requiring surgery. The optimal prosthetic valve is not established in this population. We performed a systematic review and meta-analysis to assess outcomes of patients with dialysis-dependent ESKD who received mechanical or bioprosthetic valves. METHODS: We searched Cochrane Central, Medline and Embase from inception to January 2020. We performed screening, full-text assessment, risk of bias and data collection, independently and in duplicate. Data were pooled using a random-effects model. RESULTS: = 0%, absolute effect 25 more events per 1000). CONCLUSION: Mechanical valves were associated with reduced mortality, but increased rate of bleeding and stroke. Given very low certainty for evidence of mortality and stroke outcomes, patients and clinicians may choose prosthetic valves based on factors such as bleeding risk and valve longevity. STUDY REGISTRATION: PROSPERO no. CRD42017081863.