Tissue valves are preferable for patients with end-stage renal disease: an aggregate meta-analysis

Salah E. Altarabsheh, Salil V. Deo, Shannon M Dunlay, Yaqthan M. Obeidat, Patricia J. Erwin, Abeer Rababa'h, Nagaraju Sarabhu, Suparna Navale, Yang Hyun Cho, Harveen K. Lamba, Alan H. Markowitz, Soon J. Park

Research output: Contribution to journalReview article

3 Citations (Scopus)

Abstract

BACKGROUND: Valve selection in patients with end-stage renal disease (ESRD) is uncertain. We performed a systematic review and meta-analysis to compare clinical outcome in ESRD patients undergoing valve replacement. METHODS: We systematically searched multiple databases (2000–October 2015) to identify original studies comparing adverse events between mechanical and biological valve replacement in ESRD patients. End-points studied were: postoperative mortality, bleeding events, need for re-operation, and late survival. A random-effect inverse-variance weighted analysis was performed; event rates are compared as odds ratio (OR and 95% confidence interval) and hazard ratios (HR) for time-to-event data. Mechanical valve and tissue valve replacement were considered as study and control cohorts, respectively. RESULTS: Fifteen retrospective studies (5523 mechanical and 1600 tissue valve) were included in our meta-analysis. Early mortality was comparable (OR 1.15 [0.77; 1.72]; p = 0.49). The mean follow-up among studies ranged from 1.6–15 years. Bleeding was significantly higher after mechanical valve replacement (OR 2.55 [1.53; 4.26]; p = 0.0003). Structural valve degeneration was present in only 0.6% patients after a tissue valve replacement. Overall survival after valve replacement was poor (median 2.61 years); valve choice did not influence this outcome (pooled HR 0.87 [0.73; 1.04]; p = 0.14). CONCLUSION: Operative mortality in ESRD patients is comparable between mechanical and tissue valve replacement. Major bleeding episodes are significantly higher after mechanical valve replacement but structural degeneration in tissue valves during the follow-up period is low. Based on the findings from this meta-analysis, we would recommend using tissue valves in patients with ESRD.

Original languageEnglish (US)
Pages (from-to)507-514
Number of pages8
JournalJournal of Cardiac Surgery
Volume31
Issue number8
DOIs
StatePublished - Aug 1 2016

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Chronic Kidney Failure
Meta-Analysis
Hemorrhage
Mortality
Survival
Patient Selection
Analysis of Variance
Cohort Studies
Retrospective Studies
Odds Ratio
Databases
Confidence Intervals

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Altarabsheh, S. E., Deo, S. V., Dunlay, S. M., Obeidat, Y. M., Erwin, P. J., Rababa'h, A., ... Park, S. J. (2016). Tissue valves are preferable for patients with end-stage renal disease: an aggregate meta-analysis. Journal of Cardiac Surgery, 31(8), 507-514. https://doi.org/10.1111/jocs.12805

Tissue valves are preferable for patients with end-stage renal disease : an aggregate meta-analysis. / Altarabsheh, Salah E.; Deo, Salil V.; Dunlay, Shannon M; Obeidat, Yaqthan M.; Erwin, Patricia J.; Rababa'h, Abeer; Sarabhu, Nagaraju; Navale, Suparna; Cho, Yang Hyun; Lamba, Harveen K.; Markowitz, Alan H.; Park, Soon J.

In: Journal of Cardiac Surgery, Vol. 31, No. 8, 01.08.2016, p. 507-514.

Research output: Contribution to journalReview article

Altarabsheh, SE, Deo, SV, Dunlay, SM, Obeidat, YM, Erwin, PJ, Rababa'h, A, Sarabhu, N, Navale, S, Cho, YH, Lamba, HK, Markowitz, AH & Park, SJ 2016, 'Tissue valves are preferable for patients with end-stage renal disease: an aggregate meta-analysis', Journal of Cardiac Surgery, vol. 31, no. 8, pp. 507-514. https://doi.org/10.1111/jocs.12805
Altarabsheh, Salah E. ; Deo, Salil V. ; Dunlay, Shannon M ; Obeidat, Yaqthan M. ; Erwin, Patricia J. ; Rababa'h, Abeer ; Sarabhu, Nagaraju ; Navale, Suparna ; Cho, Yang Hyun ; Lamba, Harveen K. ; Markowitz, Alan H. ; Park, Soon J. / Tissue valves are preferable for patients with end-stage renal disease : an aggregate meta-analysis. In: Journal of Cardiac Surgery. 2016 ; Vol. 31, No. 8. pp. 507-514.
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abstract = "BACKGROUND: Valve selection in patients with end-stage renal disease (ESRD) is uncertain. We performed a systematic review and meta-analysis to compare clinical outcome in ESRD patients undergoing valve replacement. METHODS: We systematically searched multiple databases (2000–October 2015) to identify original studies comparing adverse events between mechanical and biological valve replacement in ESRD patients. End-points studied were: postoperative mortality, bleeding events, need for re-operation, and late survival. A random-effect inverse-variance weighted analysis was performed; event rates are compared as odds ratio (OR and 95{\%} confidence interval) and hazard ratios (HR) for time-to-event data. Mechanical valve and tissue valve replacement were considered as study and control cohorts, respectively. RESULTS: Fifteen retrospective studies (5523 mechanical and 1600 tissue valve) were included in our meta-analysis. Early mortality was comparable (OR 1.15 [0.77; 1.72]; p = 0.49). The mean follow-up among studies ranged from 1.6–15 years. Bleeding was significantly higher after mechanical valve replacement (OR 2.55 [1.53; 4.26]; p = 0.0003). Structural valve degeneration was present in only 0.6{\%} patients after a tissue valve replacement. Overall survival after valve replacement was poor (median 2.61 years); valve choice did not influence this outcome (pooled HR 0.87 [0.73; 1.04]; p = 0.14). CONCLUSION: Operative mortality in ESRD patients is comparable between mechanical and tissue valve replacement. Major bleeding episodes are significantly higher after mechanical valve replacement but structural degeneration in tissue valves during the follow-up period is low. Based on the findings from this meta-analysis, we would recommend using tissue valves in patients with ESRD.",
author = "Altarabsheh, {Salah E.} and Deo, {Salil V.} and Dunlay, {Shannon M} and Obeidat, {Yaqthan M.} and Erwin, {Patricia J.} and Abeer Rababa'h and Nagaraju Sarabhu and Suparna Navale and Cho, {Yang Hyun} and Lamba, {Harveen K.} and Markowitz, {Alan H.} and Park, {Soon J.}",
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T1 - Tissue valves are preferable for patients with end-stage renal disease

T2 - an aggregate meta-analysis

AU - Altarabsheh, Salah E.

AU - Deo, Salil V.

AU - Dunlay, Shannon M

AU - Obeidat, Yaqthan M.

AU - Erwin, Patricia J.

AU - Rababa'h, Abeer

AU - Sarabhu, Nagaraju

AU - Navale, Suparna

AU - Cho, Yang Hyun

AU - Lamba, Harveen K.

AU - Markowitz, Alan H.

AU - Park, Soon J.

PY - 2016/8/1

Y1 - 2016/8/1

N2 - BACKGROUND: Valve selection in patients with end-stage renal disease (ESRD) is uncertain. We performed a systematic review and meta-analysis to compare clinical outcome in ESRD patients undergoing valve replacement. METHODS: We systematically searched multiple databases (2000–October 2015) to identify original studies comparing adverse events between mechanical and biological valve replacement in ESRD patients. End-points studied were: postoperative mortality, bleeding events, need for re-operation, and late survival. A random-effect inverse-variance weighted analysis was performed; event rates are compared as odds ratio (OR and 95% confidence interval) and hazard ratios (HR) for time-to-event data. Mechanical valve and tissue valve replacement were considered as study and control cohorts, respectively. RESULTS: Fifteen retrospective studies (5523 mechanical and 1600 tissue valve) were included in our meta-analysis. Early mortality was comparable (OR 1.15 [0.77; 1.72]; p = 0.49). The mean follow-up among studies ranged from 1.6–15 years. Bleeding was significantly higher after mechanical valve replacement (OR 2.55 [1.53; 4.26]; p = 0.0003). Structural valve degeneration was present in only 0.6% patients after a tissue valve replacement. Overall survival after valve replacement was poor (median 2.61 years); valve choice did not influence this outcome (pooled HR 0.87 [0.73; 1.04]; p = 0.14). CONCLUSION: Operative mortality in ESRD patients is comparable between mechanical and tissue valve replacement. Major bleeding episodes are significantly higher after mechanical valve replacement but structural degeneration in tissue valves during the follow-up period is low. Based on the findings from this meta-analysis, we would recommend using tissue valves in patients with ESRD.

AB - BACKGROUND: Valve selection in patients with end-stage renal disease (ESRD) is uncertain. We performed a systematic review and meta-analysis to compare clinical outcome in ESRD patients undergoing valve replacement. METHODS: We systematically searched multiple databases (2000–October 2015) to identify original studies comparing adverse events between mechanical and biological valve replacement in ESRD patients. End-points studied were: postoperative mortality, bleeding events, need for re-operation, and late survival. A random-effect inverse-variance weighted analysis was performed; event rates are compared as odds ratio (OR and 95% confidence interval) and hazard ratios (HR) for time-to-event data. Mechanical valve and tissue valve replacement were considered as study and control cohorts, respectively. RESULTS: Fifteen retrospective studies (5523 mechanical and 1600 tissue valve) were included in our meta-analysis. Early mortality was comparable (OR 1.15 [0.77; 1.72]; p = 0.49). The mean follow-up among studies ranged from 1.6–15 years. Bleeding was significantly higher after mechanical valve replacement (OR 2.55 [1.53; 4.26]; p = 0.0003). Structural valve degeneration was present in only 0.6% patients after a tissue valve replacement. Overall survival after valve replacement was poor (median 2.61 years); valve choice did not influence this outcome (pooled HR 0.87 [0.73; 1.04]; p = 0.14). CONCLUSION: Operative mortality in ESRD patients is comparable between mechanical and tissue valve replacement. Major bleeding episodes are significantly higher after mechanical valve replacement but structural degeneration in tissue valves during the follow-up period is low. Based on the findings from this meta-analysis, we would recommend using tissue valves in patients with ESRD.

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