Valve Selection in End-Stage Renal Disease: Should It Always Be Biological?

It appears that there is minimal difference in survival after operation for ESRD patients who undergo bioprosthetic or mechanical valve replacement, even in patients younger than 65 years. The attenuated survival of the ESRD population after valve replacement makes the increased burden of anticoagulation (particularly in hemodialysis patients) unattractive. It is likely that only a small portion of ESRD patients benefit from the increased durability of a mechanical valve.