Selection of artificial valve for the patients on hemodialysis.

The selection of artificial valve for the hemodialysis patients is still controversial. Initially ACC/AHA guideline recommended using mechanical valve because of concern on the durability of bioprosthesis after replacement on the dialysis patients; however, revised guideline deleted that recommendation. Although many reports recognized rapid deterioration of bioprosthesis mainly due to calcification after valve replacement, there is no difference on survival between both types of valve. The recently conducted meta-analysis reported the same conclusions. Actually the long-term survival of the dialysis patients is poorer than that of non-dialysis people; however, it differs according to the etiology of renal failure. For example, the long-term survival of the non-diabetic patients seems longer than that of diabetic patients requiring longer durability of artificial valve. According to ACC/AHA guideline and the meta-analysis, surgeon should not hesitate to use bioprosthetic valve; however, surgeon should consider stratification of the dialysis patients by prediction for the long survival of each patient.