Mechanical or Biological Aortic Valve Replacement in Hemodialysis Patients: A Propensity Score Matching Analysis With Long‐Term Results From the TriNetX Global Network

Background Patients on hemodialysis face elevated risks of cardiovascular disease, including calcified aortic valve pathology requiring replacement. The choice between biological and mechanical prostheses remains controversial, with limited evidence. This study compares early and long‐term outcomes of aortic valve replacement (AVR) in hemodialysis patients. Methods This retrospective cohort study analyzed data from the TriNetX global health research network. Hemodialysis patients undergoing isolated AVR with either biological or mechanical prostheses were included. Propensity score matching was performed to minimize baseline differences. Early outcomes (30‐day mortality, stroke, and hemorrhagic events) and long‐term outcomes (survival, freedom from reintervention, stroke, and hemorrhagic events) were evaluated using Kaplan–Meier estimates and Cox proportional hazards models. Results Of 1101 patients, 544 received biological prostheses and 557 received mechanical prostheses from 2005 to 2021. After propensity score matching, two well‐balanced groups of 427 patients each were analyzed. At 30 days, no significant differences were observed in mortality (10.5% vs. 8.4%, p = 0.270) or stroke incidence (5.1% in both, p = 0.983). At 7 years, freedom from reintervention was significantly higher in the mechanical group (91.2% vs. 80%, p = 0.025), while survival remained poor in both groups (33.2% vs. 29.9%, p = 0.351). Rates of stroke and hemorrhagic events were similar between groups. Conclusions There was no significant difference in long‐term survival between the two groups. Prosthesis choice should be individualized, considering life expectancy, quality of life, and transplant candidacy.