Division of Cardiac Surgery, University of Ottawa, Ottawa, Ontario, Canada.
Heart. 2011 Dec;97(24):2033-7. doi: 10.1136/heartjnl-2011-300727. Epub 2011 Oct 11.
There is little evidence guiding heart valve prosthesis selection in patients with end-stage renal disease (ESRD) on dialysis.
To perform: 1) a systematic review of studies examining valve replacement in patients with ESRD on dialysis; and 2) a quantitative meta-analysis comparing survival and valve-related outcomes following valve replacement with bioprostheses versus mechanical prostheses in this population.
English studies published from 1990 onwards.
Studies were included in the meta-analysis if they compared bioprostheses with mechanical prostheses in patients with ESRD on dialysis.
Extracted summary estimates included the hazard ratio (HR) for death, and the odds ratio (OR) for developing valve-related complications due to the use of bioprostheses versus mechanical prosthesis.
Twelve studies published from 1997 to 2010 were included in this review, of which 9 were used in the meta-analysis. No evidence of publication bias was detected. The aortic valve was the most common valve replaced in these studies (4339/6350), although 11 of the 12 studies also included mitral or multiple valve replacements. No difference in survival was observed between valve types (bioprostheses versus mechanical prostheses hazard ratio 1.3, 95% confidence interval (CI) 1.0-1.9, p = 0.09). However, valve replacement with bioprostheses was associated with fewer valve-related complications compared to mechanical prostheses (odds ratio 0.4, 95% CI 0.2-0.7, p = 0.002).
A meta-analysis of the published literature demonstrates no survival difference following valve replacement with either bioprostheses or mechanical prosthesis in patients with ESRD on dialysis. Bioprosthetic valve replacement was associated with fewer valve-related complications. Although this meta-analysis cannot discriminate between the sites of valve implant, these data can likely be extended to include at least aortic valve replacement.
在接受透析治疗的终末期肾病（ESRD）患者中，心脏瓣膜假体选择的证据很少。
进行：1）系统回顾检查 ESRD 透析患者瓣膜置换的研究；2）对该人群中生物假体与机械假体置换后生存和瓣膜相关结局进行定量荟萃分析。
1990 年以后发表的英文研究。
如果研究比较了 ESRD 透析患者的生物假体与机械假体，那么该研究将被纳入荟萃分析。
提取的综合估计包括死亡的风险比（HR）和由于使用生物假体与机械假体而导致瓣膜相关并发症的几率比（OR）。
本综述纳入了 1997 年至 2010 年发表的 12 项研究，其中 9 项研究被纳入荟萃分析。未发现发表偏倚的证据。这些研究中最常见的置换瓣膜为主动脉瓣（4339/6350），尽管其中 11 项研究还包括二尖瓣或多瓣膜置换。瓣膜类型之间的生存率无差异（生物假体与机械假体 HR 1.3，95%置信区间（CI）1.0-1.9，p = 0.09）。然而，与机械假体相比，生物假体置换与较少的瓣膜相关并发症相关（OR 0.4，95%CI 0.2-0.7，p = 0.002）。
对已发表文献的荟萃分析表明，在接受透析治疗的 ESRD 患者中，生物假体或机械假体置换后生存率无差异。生物假体瓣膜置换与较少的瓣膜相关并发症相关。尽管这项荟萃分析无法区分瓣膜植入部位，但这些数据可能至少可以扩展到包括主动脉瓣置换。
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