Are homografts superior to conventional prosthetic valves in the setting of infective endocarditis involving the aortic valve?

Kim, Joon Bum; Ejiofor, Julius I.; Yammine, Maroun; Camuso, Janice; Walsh, Conor; Ando, Masahiko; Melnitchouk, Serguei; Rawn, James D.; Leacche, Marzia; MacGillivray, Thomas E.; Cohn, Lawrence H.; Byrne, John G.; Sundt, Thoralf M.

doi:10.1016/j.jtcvs.2015.12.061

Cited by 82 publications

(131 citation statements)

References 26 publications

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“…When simple valve replacement is required, choice of valve-mechanical or tissue prosthesis-should be based on normal criteria: age, life expectancy, comorbidities, and expected compliance with anticoagulation. For patients with invasive disease and destruction, reconstruction should depend on the involved valve, severity of destruction, and available options for cardiac reconstruction Several studies have suggested that use of an allograft in patients with aortic valve IE is associated with better survival and lower risk of relapse (no early phase of recurrent infection) (43)(44)(45)(46). Due to technical difficulty and lack of evidence of superior resistance to reinfection, many surgeons prefer other conduits for reconstruction (44).…”

Section: General Considerations and Recommendations For Choice Of Recmentioning

confidence: 99%

Current AATS guidelines on surgical treatment of infective endocarditis

Pettersson¹,

Hussain²

2019

Ann. Cardiothorac. Surg.

148

116

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The 2016 American Association for Thoracic Surgery (AATS) guidelines for surgical treatment of infective endocarditis (IE) are question based and address questions of specific relevance to cardiac surgeons. Clinical scenarios in IE are often complex, requiring prompt diagnosis, early institution of antibiotics, and decisionmaking related to complications, including risk of embolism and timing of surgery when indicated. The importance of an early, multispecialty team approach to patients with IE is emphasized. Management issues are divided into groups of questions related to indications for and timing of surgery, pre-surgical work-up, preoperative antibiotic treatment, surgical risk assessment, intraoperative management, surgical management, surveillance, and follow up. Standard indications for surgery are severe heart failure, severe valve dysfunction, prosthetic valve infection, invasion beyond the valve leaflets, recurrent systemic embolization, large mobile vegetations, or persistent sepsis despite adequate antibiotic therapy for more than 5-7 days. The guidelines emphasize that once an indication for surgery is established, the operation should be performed as soon as possible. Timing of surgery in patients with strokes and neurologic deficits require close collaboration with neurological services. In surgery infected and necrotic tissue and foreign material is radically debrided and removed. Valve repair is performed whenever possible, particularly for the mitral and tricuspid valves. When simple valve replacement is required, choice of valve-mechanical or tissue prosthesis-should be based on normal criteria for valve replacement. For patients with invasive disease and destruction, reconstruction should depend on the involved valve, severity of destruction, and available options for cardiac reconstruction.For the aortic valve, use of allograft is still favored.

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Section: General Considerations and Recommendations For Choice Of Recmentioning

confidence: 99%

Current AATS guidelines on surgical treatment of infective endocarditis

Pettersson¹,

Hussain²

2019

Ann. Cardiothorac. Surg.

148

116

View full text Add to dashboard Cite

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“…The mean age of patients receiving bioprosthetic valves calculated from six studies reporting mean age of patients (19,20,22,23,28,29) was 59.2 years old (95% CI: 58.2-60.1). The mean age of patients receiving mechanical valves was 52.1 years old (95% CI: 51.4-52.9).…”

Section: Resultsmentioning

confidence: 99%

Systematic review and meta-analysis of surgical outcomes comparing mechanical valve replacement and bioprosthetic valve replacement in infective endocarditis

Flynn¹,

Curran²,

Chan³

et al. 2019

Ann. Cardiothorac. Surg.

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Background: 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.Methods: 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.Results: 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). Conclusions: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.

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“…The optimal prosthesis has been debated for decades in the treatment of PVE[25]. Because of the advantages of removing the abscess, larger valve area, anti-infective and anti-coagulation therapy, surgical dogma indicate that a homograft or allograft is more beneficial than a prosthetic valve in the infected field[26]. However, the structural degradation and complicated surgical methods have limited their application [9,27].…”

Section: Discussionmentioning

confidence: 99%

“…However, the structural degradation and complicated surgical methods have limited their application [9,27]. A prospective study [26] from the databases of 2 tertiary academic centers suggested no difference in the prognosis of homograft and prosthetic valves in patients with IE. Our study suggested that there was a statistically significant higher trend of relapse in the biological valve group.…”

Section: Discussionmentioning

confidence: 99%

“…Research has found that 30% of the cases of healthcare-associated IE were related with aseptic measures during venous catheter manipulation and during any invasive procedures[3]. Kim and colleagues[26] found no difference in the incidence of recurrence between the biological valve group and the mechanical valve group. The study by Moon et al[10] suggested that the rate of recurrent endocarditis during the first 5 years was 3.6% per patient-year in the mechanical valve group, and 2.1% per patient-year in the biological valve group.…”

Section: Discussionmentioning

confidence: 99%

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The prognosis of infective endocarditis treated with biological valves versus mechanical valves: A meta-analysis

et al. 2017

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ObjectiveSurgery remains the primary form of treatment for infective endocarditis (IE). However, it is not clear what type of prosthetic valve provides a better prognosis. We conducted a meta-analysis to compare the prognosis of infective endocarditis treated with biological valves to cases treated with mechanical valves.MethodsPubmed, Embase and Cochrane databases were searched from January 1960 to November 2016.Randomized controlled trials, retrospective cohorts and prospective studies comparing outcomes between biological valve and mechanical valve management for infective endocarditis were analyzed. The Newcastle-Ottawa Scale(NOS) was used to evaluate the quality of the literature and extracted data, and Stata 12.0 software was used for the meta-analysis.ResultsA total of 11 publications were included; 10,754 cases were selected, involving 6776 cases of biological valves and 3,978 cases of mechanical valves. The all-cause mortality risk of the biological valve group was higher than that of the mechanical valve group (HR = 1.22, 95% CI 1.03 to 1.44, P = 0.023), as was early mortality (RR = 1.21, 95% CI 1.02 to 1.43, P = 0.033). The recurrence of endocarditis (HR = 1.75, 95% CI 1.26 to 2.42, P = 0.001), as well as the risk of reoperation (HR = 1.79, 95% CI 1.15 to 2.80, P = 0.010) were more likely to occur in the biological valve group. The incidence of postoperative embolism was less in the biological valve group than in the mechanical valve group, but this difference was not statistically significant (RR = 0.90, 95% CI 0.76 to 1.07, P = 0.245). For patients with prosthetic valve endocarditis (PVE), there was no significant difference in survival rates between the biological valve group and the mechanical valve group (HR = 0.91, 95% CI 0.68 to 1.21, P = 0.520).ConclusionThe results of our meta-analysis suggest that mechanical valves can provide a significantly better prognosis in patients with infective endocarditis. There were significant differences in the clinical features of patients receiving a biological valve compared to patients receiving a mechanical valve. A large, multicenter retrospective study included in our meta-analysis suggested that any mortality risk of the biological valve group was significant higher than that of the mechanical valve group. However, the risk was no different after risk was adjusted. So, we thought the reason for this result may be related to the characteristics of the patient rather than valve dysfunction. It is still necessary to future randomized studies to verify this conclusion.

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Are homografts superior to conventional prosthetic valves in the setting of infective endocarditis involving the aortic valve?

Cited by 82 publications

References 26 publications

Current AATS guidelines on surgical treatment of infective endocarditis

Current AATS guidelines on surgical treatment of infective endocarditis

Systematic review and meta-analysis of surgical outcomes comparing mechanical valve replacement and bioprosthetic valve replacement in infective endocarditis

The prognosis of infective endocarditis treated with biological valves versus mechanical valves: A meta-analysis

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