Systematic review and meta-analysis of surgical outcomes comparing mechanical valve replacement and bioprosthetic valve replacement in infective endocarditis
Flynn, Campbell D. (St George Hospital)
Curran, Neil P. (St George Hospital)
Chan, Stephanie (St George Hospital)
Zegrí-Reiriz, Isabel (Institut d'Investigació Biomèdica Sant Pau)
Taurón, Manel (Institut d'Investigació Biomèdica Sant Pau)
Tian, David H. (Macquarie University)
Pettersson, Gosta B. (Cleveland Clinic)
Coselli, Joseph S. (Texas Heart Institute)
Misfeld, Martin (University Department for Cardiac Surgery)
Antunes, Manuel J. (University of Coimbra Medical School)
Mestres, Carlos A. (The University of the Free State)
Quintana, Eduard (Hospital Clínic i Provincial de Barcelona)
Universitat Autònoma de Barcelona

Date:	2019
Abstract:	Infective endocarditis (IE) is an infection involving either native or prosthetic heart valves, the endocardial surface of the heart or any implanted intracardiac devices. IE is a rare condition affecting 3-15 patients per 100,000 population. In-hospital mortality rates in patients with IE remain high at around 20% despite treatment advances. There is no consensus recommendation favoring either bioprosthetic valve or mechanical valve implantation in the setting of IE; patient age, co-morbidities and preferences should be considered selecting the replacement prosthesis. A systematic review and meta-analysis of studies reporting the outcomes of patients undergoing bioprosthetic or mechanical valve replacement for infective endocarditis with data extracted for overall survival, valve reinfection rates and valve reoperation. Eleven relevant studies were identified, with 2,336 patients receiving a mechanical valve replacement and 2,057 patients receiving a bioprosthetic valve replacement. There was no significant difference for overall survival between patients treated with mechanical valves and those treated with bioprosthetic valves [hazard ratio (HR) 0. 94, 95% confidence interval (CI): 0. 73-1. 21, P=0. 62]. There was no significant difference in reoperation rates between patients treated with a bioprosthetic valve and those treated with a mechanical valve (HR 0. 82, 95% CI: 0. 34-1. 98, P=0. 66) and there was no significant difference in the rate of valve reinfection rates (HR 0. 95, 95% CI: 0. 48-1. 89, P=0. 89). The presence of infective endocarditis alone should not influence the decision of which type of valve prosthesis that should be implanted. This decision should be based on patient age, co-morbidities and preferences.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Bioprosthesis ; Bioprosthetic ; Infective endocarditis ; Mechanical ; Tissue valve ; Valve replacement
Published in:	Annals of Cardiothoracic Surgery, Vol. 8 Núm. 6 (2019) , p. 587-599, ISSN 2304-1021

DOI: 10.21037/acs.2019.10.03
PMID: 31832349

15 p, 1.4 MB

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Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Institut de Recerca Sant Pau
Articles > Research articles
Articles > Published articles