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

This single-center retrospective study evaluated outcomes of ESRD patients undergoing valve surgery based on whether they received either a mechanical or tissue valve.  The study spanned the years 2002-2014, and included 64 mechanical and 151 tissue valve replacements.  Even after controlling for confounding variables–given the short expected survival in these patients–there is no salutary effect of using a mechanical over a tissue valve.  

Comment:  Given the morbidity of anticoagulation in, and the shorter lifespan of, ESRD patients, should we be using mechanical valves at all in these patients?