Patients with renal disease on dialysis have significant comorbidity limiting life expectancy, however these patients may experience accelerated prosthetic valve degeneration. The purpose of the current study was to examine the impact of prosthesis choice on outcomes in dialysis patients undergoing mitral valve replacement (MVR) at our high-volume academic center.
Adults undergoing MVR were retrospectively reviewed between Jan 2002-Nov 2019. Patients were included if they had documented renal failure and dialysis requirements prior to presentation. Patients were stratified by mechanical vs. bioprosthetic prosthesis. Mortality and recurrent severe valve failure (3+ or greater) or redo mitral operation were utilized as primary outcomes.
177 dialysis patients were identified who underwent MVR. Of these, 118 (66.7%) received bioprosthetic while 59 (33.3%) received mechanical valves. Those who received mechanical valves were younger (48 vs. 61, p<0.001) and had less diabetes (32% vs. 51%, p=0.019). Endocarditis and atrial fibrillation prevalence were similar. Postoperative length of stay was non-different between groups. Risk-adjusted hazard for 5-year mortality was similar between groups (p=0.668). Early mortality was high, with both groups having <50% actuarial survival at 2y. No differences were noted in rates of structural valve deterioration or reintervention. More stroke events were noted on follow-up in mechanical patients (15% vs. 6%, p=0.041). Endocarditis was the leading reason for reintervention, while four patients received repeat surgery for bioprosthetic valve failure.
MVR in dialysis patients carries significant morbidity and increased mid-term mortality. Decreased life-expectancy should be considered in the tailoring of prosthesis choice to dialysis-dependent patients.

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