Nota: estas Atualizações se prestam a informar e não a substituir o julgamento clínico do médico que, em última análise, deve determinar o tratamento apropriado para seus pacientes.
BackgroundThe choice of a mechanical (MP) or biological prosthesis (BP) for patients
with valvular heart disease undergoing replacement is still not a
consensus.ObjectiveWe aimed to determine the clinical outcomes of MP or BP placement in those
patients.MethodsWe conducted a systematic review and meta-analysis of randomized controlled
trials (RCTs) that compared biological prostheses and mechanical prostheses
in patients with valvular heart diseases and assessed the outcomes. RCTs
were searched in the MEDLINE, EMBASE, LILACS, CENTRAL, SCOPUS and Web of
Science (from inception to November 2014) databases. Meta-analyses were
performed using inverse variance with random effects models. The GRADE
system was used to rate the quality of the evidence. A P-value lower than
0.05 was considered significant.ResultsA total of four RCTs were included in the meta-analyses (1,528 patients) with
follow up ranging from 2 to 20 years. Three used old generation mechanical
and biological prostheses, and one used contemporary prostheses. No
significant difference in mortality was found between BP and MP patients
(risk ratio (RR = 1.07; 95% CI 0.99-1.15). The risk of bleeding was
significantly lower in BP patients than MP patients (RR = 0.64; 95% CI
0.52-0.78); however, reoperations were significantly more frequent in BP
patients (RR = 3.60; 95% CI 2.44-5.32). There were no statistically
significant differences between BP and MP patients with respect to systemic
arterial embolisms and infective endocarditis (RR = 0.93; 95% CI 0.66-1.31,
RR = 1.21; CI95% 0.78-1.88, respectively). Results in the trials with modern
and old prostheses were similar.ConclusionsThe mortality rate and the risk of thromboembolic events and endocarditis
were similar between BP and MP patients. The risk of bleeding was
approximately one third lower for BP patients than for MP patients, while
the risk of reoperations was more than three times higher for BP
patients.
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