Comparison of Biological and Mechanical Prostheses for Heart Valve Surgery: A Systematic Review of Randomized Controlled Trials

Abstract

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.

Mortalidade de pacientes submetidos à cirurgia cardíaca

“…O que vai de encontro com o presente estudo, onde a cirurgia mais realizada foi à revascularização do miocárdio (38,7%) e a cirurgia com maior número de complicações, pós-operatória, foi a valvuloplastia ou troca valvar. Na revisão sistemática de estudos randomizados de Kiyose et al (2019), que avaliou os desfechos de pacientes que receberam aleatoriamente próteses valvares biológicas e mecânicas, mostrou que, apesar de não haver diferenças na mortalidade, há um aumento significativo no risco de nova cirurgia de substituição valvar ao se optar por próteses biológicas.…”

Tricuspid Valve Repair with Autologous Pericardium in a Patient with Infective Endocarditis

“…In terms of the surgical technique, valvular replacement with biological or mechanical prostheses is recommended [ 3 ] . However, utilizing these valves brings complications, such as risk of bleeding, reintervention, embolism, and endocarditis [ 7 ] . In our case, we decided to perform complete reconstruction of the tricuspid valve with an autologous pericardium, which had fenestrations to ease ventricular filling and avoid increase in transvalvular gradient.…”

Os Top 10 Artigos Originais Publicados nos Arquivos Brasileiros de Cardiologia e na Revista Portuguesa de Cardiologia em 2019

“…Os autores salientam a ausência de estudos com as novas gerações de próteses, exortando a realização de estudos que comparem próteses biológicas e mecânicas contemporâneas. 28 …”

“…The authors highlight the lack of studies on the new generation valvular prostheses, emphasizing the need to compare contemporary mechanical and biological valvular prostheses. 28 …”