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Heart valve prosthesis selection in patients with end-stage renal disease requiring dialysis: a systematic review and meta-analysis
  1. Andreas Böning1,
  2. Martin Brück2
  1. 1Department of Cardiovascular Surgery, University Hospital Giessen and Marburg, Giessen, Germany
  2. 2Department of Cardiology and Nephrology, Lahn-Dill-Kliniken, Wetzlar, Germany
  1. Correspondence to Dr Andreas Böning, Department of Cardiovascular Surgery, University Hospital Giessen and Marburg, Rudolf-Buchheim-Strasse7, 35385 Giessen, Germany; andreas.boening{at}chiru.med.uni-giessen.de

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Sometimes, the critical reader of biomedical journals witnesses a paradigm shift in treatment recommendations. While the 1998 guidelines recommend the use of mechanical, not bioprosthetic, heart valve prostheses in patients with end-stage renal disease (ESRD) requiring dialysis, the 2005 revised guidelines are less prescriptive because of insufficient data, leaving open the question of the optimum choice. The meta-analysis of Chan et al1 published recently in Heart has the potential to complete the paradigm shift by influencing future guideline recommendations to favour bioprosthetic heart valves as the first choice for patients with ESRD.

The 5-year mortality rate of patients with ESRD is approximately 65%.1 In addition, the life expectancy of a chronic dialysis patient in the seventh decade is only 3.8–4.5 years. …

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