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Prosthetic Valve in Chronic Dialysis: a Systematic Review and Meta-Analysis
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  • Emilie Belley-Côté,
  • Saurabh Gupta,
  • Arjun Pandey,
  • Ali Alsagheir,
  • Ahmed Makhdoum,
  • Graham McClure,
  • Brooke Newsome,
  • Sophie Gao,
  • Matthias Bossard,
  • Tetsuya Isayama,
  • Yasuhisa Ikuta,
  • Michael Walsh,
  • Amit Garg,
  • Gordon H. Guyatt,
  • Richard Whitlock,
  • Kevin Kim
Emilie Belley-Côté
McMaster University Faculty of Health Sciences
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Saurabh Gupta
McMaster University
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Arjun Pandey
McMaster University Michael G DeGroote School of Medicine
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Ali Alsagheir
McMaster University Faculty of Health Sciences
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Ahmed Makhdoum
University of Toronto
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Graham McClure
McMaster University Faculty of Health Sciences
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Brooke Newsome
McMaster University Faculty of Health Sciences
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Sophie Gao
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Matthias Bossard
Luzerner Kantonsspital
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Tetsuya Isayama
National Center for Child Health and Development
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Yasuhisa Ikuta
National Center for Child Health and Development
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Michael Walsh
McMaster University Faculty of Health Sciences
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Amit Garg
McMaster University
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Gordon H. Guyatt
McMaster University Faculty of Health Sciences
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Richard Whitlock
McMaster University Faculty of Health Sciences
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Kevin Kim
McMaster University Faculty of Health Sciences
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Abstract

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 assessing 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. We evaluated risk of bias using the ROBINS-I tool and certainty in evidence with GRADE. Data were pooled using a random-effects model. Results: We identified 28 observational studies (n=9857; 6680 mechanical and 3717 bioprosthetic) with a median follow-up of 3.45 years. Due to confounding, 22 studies were at “high” and one at “critical” risk of bias. Certainty in evidence for all outcomes, except for bleeding, was very-low. Mechanical valves were associated with reduced mortality at 30 days (RR0.79, 95%CI[0.65,0.97], I2=0, absolute effect 27 fewer deaths per 1000) and at ≥ 6 years (mean 9.7 years, RR0.83, 95%CI[0.72,0.96], I2=79%, absolute effect 145 fewer deaths per 1000), but increased bleeding (RR2.46, 95%CI[1.35,4.48], I2=69% absolute effect 113 more events per 1000) and stroke (RR1.53, 95%CI[1.13,2.07], I2=0%, absolute effect 21 more events per 1000). Conclusion: Mechanical valves are associated with reduced mortality, but increased risks of bleeding and stroke. Given very-low certainty for mortality and stroke, patients and clinicians may choose a prosthetic valve based on factors such as bleeding risk and valve longevity.