{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T12:57:00Z","timestamp":1776689820710,"version":"3.51.2"},"reference-count":34,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T00:00:00Z","timestamp":1776643200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003725","name":"Ministry of Education","doi-asserted-by":"publisher","award":["RS-2025-25434005"],"award-info":[{"award-number":["RS-2025-25434005"]}],"id":[{"id":"10.13039\/501100003725","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Earlier studies in patients with end-stage renal dysfunction (ESRD) reported no significant difference in long-term outcomes between mechanical and tissue valves after valve surgery, largely due to the limited life expectancy of this population. As survival in patients with ESRD has improved in recent years, this study evaluated whether increased life expectancy affects long-term outcomes according to valve type in patients with ESRD undergoing aortic valve replacement (AVR) using a nationwide cohort. Methods: We analyzed data from the Korean National Health Insurance Service database from January 2005 to December 2021. Among 474 patients with ESRD who underwent AVR, 279 received tissue valves and 195 received mechanical valves. Propensity score matching was performed to balance baseline characteristics, yielding 99 matched patient pairs. Results: In the matched cohort, early mortality (within 30 days) was significantly higher in the tissue valve group (16.2% vs. 4.0%; p = 0.008). However, long-term survival rates at 1, 5, and 10 years did not differ significantly between the groups (all p &gt; 0.05). Stratification by operative era (2005\u20132013 vs. 2014\u20132021) similarly showed no significant impact of valve type on survival despite temporal advances in care. Conclusions: Long-term survival and complication rates after AVR in patients with ESRD were comparable between mechanical and tissue valves across operative eras. Valve selection should be guided by shared decision-making, incorporating individual life expectancy and comorbidity profiles rather than assuming mechanical valves as the default option.<\/jats:p>","DOI":"10.3390\/jcm15083127","type":"journal-article","created":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T12:01:22Z","timestamp":1776686482000},"page":"3127","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of Improved End-Stage Renal Disease Patient Survival on Prosthetic Valve Selection in Aortic Valve Replacement: A Nationwide Cohort Analysis"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6556-2261","authenticated-orcid":false,"given":"Kyungsub","family":"Song","sequence":"first","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, Keimyung University Dongsan Hospital, Keimyung University College of Medicine, Daegu 42601, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3202-2696","authenticated-orcid":false,"given":"Yun Jin","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Pre-Medicine, College of Medicine, Hanyang University, Seoul 04763, Republic of Korea"},{"name":"Biostatistics Lab, Medical Research Collaborating Center, Hanyang University, Seoul 04763, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Woo Sung","family":"Jang","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, Keimyung University Dongsan Hospital, Keimyung University College of Medicine, Daegu 42601, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7054-1898","authenticated-orcid":false,"given":"YoHan","family":"Bae","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, Keimyung University Dongsan Hospital, Keimyung University College of Medicine, Daegu 42601, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1938-6412","authenticated-orcid":false,"given":"Ji Eon","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul 02841, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8848-4112","authenticated-orcid":false,"given":"Jae-Seung","family":"Jung","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul 02841, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8237-2542","authenticated-orcid":false,"given":"Jun Ho","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul 02841, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"A7","DOI":"10.1053\/j.ajkd.2019.01.001","article-title":"US Renal Data System 2018 Annual Data Report: Epidemiology of Kidney Disease in the United States","volume":"73","author":"Saran","year":"2019","journal-title":"Am. J. Kidney Dis."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2057","DOI":"10.1016\/j.jtcvs.2020.05.101","article-title":"Mechanical or biological heart valve for dialysis-dependent patients? A meta-analysis","volume":"163","author":"Chi","year":"2022","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1949","DOI":"10.1161\/01.CIR.98.18.1949","article-title":"Guidelines for the management of patients with valvular heart disease: Executive summary. A report of the American College of Cardiology\/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Valvular Heart Disease)","volume":"98","author":"Bonow","year":"1998","journal-title":"Circulation"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1336","DOI":"10.1161\/hc1102.100075","article-title":"Long-term survival of dialysis patients in the United States with prosthetic heart valves: Should ACC\/AHA practice guidelines on valve selection be modified?","volume":"105","author":"Herzog","year":"2002","journal-title":"Circulation"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1007\/s11748-008-0365-1","article-title":"Cardiac valvular surgery in dialysis patients: Comparison of surgical outcome for mechanical versus bioprosthetic valves","volume":"57","author":"Umezu","year":"2009","journal-title":"Gen. Thorac. Cardiovasc. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/j.athoracsur.2009.10.026","article-title":"Early and late outcomes of aortic valve replacement in dialysis patients","volume":"89","author":"Tanaka","year":"2010","journal-title":"Ann. Thorac. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1127","DOI":"10.1016\/j.athoracsur.2010.12.056","article-title":"Long-term survival for patients with preoperative renal failure undergoing bioprosthetic or mechanical valve replacement","volume":"91","author":"ThouThourani","year":"2011","journal-title":"Ann. Thorac. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/j.jtcvs.2011.07.057","article-title":"Short- and long-term outcomes in patients undergoing valve surgery with end-stage renal failure receiving chronic hemodialysis","volume":"144","author":"Thourani","year":"2012","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1016\/j.jtcvs.2018.10.168","article-title":"A 20-year multicenter analysis of dialysis-dependent patients who had aortic or mitral valve replacement: Implications for valve selection","volume":"158","author":"Manghelli","year":"2019","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_10","first-page":"743","article-title":"The significance of prosthesis type on survival following valve replacement in dialysis patients","volume":"22","author":"Skripochnik","year":"2013","journal-title":"J. Heart Valve Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2033","DOI":"10.1136\/heartjnl-2011-300727","article-title":"Heart valve prosthesis selection in patients with end-stage renal disease requiring dialysis: A systematic review and meta-analysis","volume":"97","author":"Chan","year":"2011","journal-title":"Heart"},{"key":"ref_12","first-page":"e35","article-title":"2020 ACC\/AHA Guideline for the Management of Patients with Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"143","author":"Otto","year":"2021","journal-title":"Circulation"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"745370","DOI":"10.3389\/fcvm.2021.745370","article-title":"Long-Term Outcomes of Bioprosthetic or Mechanical Valve Replacement in End-Stage Renal Disease: A Nationwide Population-Based Retrospective Study","volume":"8","author":"Li","year":"2021","journal-title":"Front Cardiovasc. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1177\/02184923241301108","article-title":"Mechanical versus bioprosthetic valve for aortic valve replacement in dialysis patients: Systematic review and individual patient data meta-analysis","volume":"32","author":"Zoupas","year":"2024","journal-title":"Asian Cardiovasc. Thorac. Ann."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1111\/jocs.12805","article-title":"Tissue valves are preferable for patients with end-stage renal disease: An aggregate meta-analysis","volume":"31","author":"Altarabsheh","year":"2016","journal-title":"J. Card. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e009252","DOI":"10.1161\/CIRCINTERVENTIONS.120.009252","article-title":"Management of Aortic Stenosis in Patients with End-Stage Renal Disease on Hemodialysis","volume":"13","author":"Mentias","year":"2020","journal-title":"Circ. Cardiovasc. Interv."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e019930","DOI":"10.1161\/JAHA.120.019930","article-title":"Long-Term Outcomes of Transcatheter Aortic Valve Replacement in Patients with End-Stage Renal Disease","volume":"10","author":"Ogami","year":"2021","journal-title":"J. Am. Heart Assoc."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1038\/s41581-024-00820-6","article-title":"Chronic kidney disease and the global public health agenda: An international consensus","volume":"20","author":"Francis","year":"2024","journal-title":"Nat. Rev. Nephrol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"A7","DOI":"10.1053\/j.ajkd.2021.01.002","article-title":"US Renal Data System 2020 Annual Data Report: Epidemiology of Kidney Disease in the United States","volume":"77","author":"Johansen","year":"2021","journal-title":"Am. J. Kidney Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2528","DOI":"10.1093\/ndt\/gfad099","article-title":"Patient-focused outcomes after initiation of dialysis for ESRD: Mortality, hospitalization and functional impairment","volume":"38","author":"Kolbrink","year":"2023","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"91","DOI":"10.2215\/CJN.04330417","article-title":"Changes in Excess Mortality from End Stage Renal Disease in the United States from 1995 to 2013","volume":"13","author":"Foster","year":"2018","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"ezaf018","DOI":"10.1093\/ejcts\/ezaf018","article-title":"Prognostic impact of 1-year permanent pacemaker implantation after mitral valve surgery with the Cox-maze procedure","volume":"67","author":"Lee","year":"2025","journal-title":"Eur. J. Cardiothorac Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"101012","DOI":"10.1016\/j.xkme.2025.101012","article-title":"Time Trends and Causes of Infection-Related Mortality Among Patients Starting Dialysis in Finland: A Nationwide Cohort Study","volume":"7","author":"Kinnunen","year":"2025","journal-title":"Kidney Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"sfaf215","DOI":"10.1093\/ckj\/sfaf215","article-title":"Long-term mortality and technique survival in peritoneal dialysis patients: A 25-year retrospective analysis in a single center","volume":"18","author":"Scarmignan","year":"2025","journal-title":"Clin. Kidney J."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Pliquett, R.U. (2022). Cardiorenal Syndrome: An Updated Classification Based on Clinical Hallmarks. J. Clin. Med., 11.","DOI":"10.3390\/jcm11102896"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1038\/nrneph.2017.52","article-title":"The systemic nature of CKD","volume":"13","author":"Zoccali","year":"2017","journal-title":"Nat. Rev. Nephrol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"132585","DOI":"10.1016\/j.ijcard.2024.132585","article-title":"An in-depth look at electrolytes in acute heart failure: The role of sodium-to-chloride ratio","volume":"417","author":"Trimarchi","year":"2024","journal-title":"Int. J. Cardiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1524","DOI":"10.1016\/j.athoracsur.2014.11.055","article-title":"Valve selection for the aortic position in dialysis patients","volume":"99","author":"Okada","year":"2015","journal-title":"Ann. Thorac. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1016\/j.jacc.2017.07.715","article-title":"Aortic Bioprosthetic Valve Durability: Incidence, Mechanisms, Predictors, and Management of Surgical and Transcatheter Valve Degeneration","volume":"70","author":"Voisine","year":"2017","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1681\/ASN.2008040349","article-title":"Association of serum phosphate with vascular and valvular calcification in moderate CKD","volume":"20","author":"Adeney","year":"2009","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e018971","DOI":"10.1161\/JAHA.120.018971","article-title":"Outcomes of Surgical Mitral and Aortic Valve Replacements Among Kidney Transplant Candidates: Implications for Valve Selection","volume":"10","author":"Ngendahimana","year":"2021","journal-title":"J. Am. Heart Assoc."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"769","DOI":"10.21037\/jtd.2016.02.74","article-title":"Bioprosthetic versus mechanical prostheses for valve replacement in end-stage renal disease patients: Systematic review and meta-analysis","volume":"8","author":"Phan","year":"2016","journal-title":"J. Thorac. Dis."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"E450","DOI":"10.1503\/cjs.001121","article-title":"Mechanical versus bioprosthetic valves in chronic dialysis: A systematic review and meta-analysis","volume":"65","author":"Kim","year":"2022","journal-title":"Can. J. Surg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"334","DOI":"10.5761\/atcs.oa.21-00093","article-title":"Durability of Bioprosthetic Valves in Patients on Dialysis","volume":"28","author":"Uzuka","year":"2022","journal-title":"Ann. Thorac. Cardiovasc. Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/8\/3127\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T12:28:41Z","timestamp":1776688121000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/8\/3127"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,20]]},"references-count":34,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["jcm15083127"],"URL":"https:\/\/doi.org\/10.3390\/jcm15083127","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,20]]}}}