Question

how to use daillysis mechanical

Answer 1

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.

Keywords: Valve replacement, Dialysis, Mechanical, Tissue

INTRODUCTION

A best evidence topic was constructed according to a structured protocol. This is fully described in the ICVTS [1].

THREE-PART QUESTION

In [patients with end-stage renal disease undergoing a valve replacement] is [a mechanical or a bioprosthetic valve] superior [for immediate and long-term survival].

CLINICAL SCENARIO

In a multidisciplinary team meeting, a 55-year old patient with end-stage renal disease (ESRD) is referred for a valve replacement. You would usually place a mechanical valve in patients of this age but you wonder, with his regular dialysis, potential for renal transplantation and reduced life expectancy, whether a tissue valve would not be better for him so that he can avoid warfarin. You decide to review the literature on this subject.

SEARCH STRATEGY

Medline 1948 to November 2011 with OVID SP (exp Heart Valve Prosthesis/ OR valve replacement.mp. OR AVR.mp) AND (end stage renal disease.mp. or exp Kidney Failure, Chronic/ OR exp Renal Dialysis/ or haemodialysis.mp).

SEARCH OUTCOME

Two hundred and forty-seven papers were found using the reported search. From these, eight papers were identified, which provided the best evidence to answer the question. These are presented in Table 1.