Bioprosthetic Versus Mechanical Valve Replacement for Infective Endocarditis: Focus on Recurrence Rates

Toyoda, Nana; Itagaki, Shinobu; Tannous, Henry; Egorova, Natalia; Chikwe, Joanna

doi:10.1016/j.athoracsur.2017.12.046

Cited by 43 publications

(46 citation statements)

References 26 publications

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“…There is no consensus recommendation of either bioprostheses or mechanical valve in the setting of IE, comorbidities and preferences should be considered in making the decision for prosthetic valve selection. A few studies comparing mechanical and biological prostheses in IE patients lead to contradictory results 4‐6 . For the general population with mitral valve disease, the European Society of Cardiology suggested surgery with mechanical valves for patients under 65 year while bioprosthesis for patients older than 70 year 7 ; the American Heart Association guidelines recommend a mechanical valve prosthesis in patients under the age of 50 and a bioprostheses valve prosthesis over the age of 70 8 .…”

Section: Introductionmentioning

confidence: 99%

Bioprosthetic vs mechanical mitral valve replacement for infective endocarditis in patients aged 50 to 69 years

Jiang

Xie

et al. 2020

Clinical Cardiology

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Background: The optimal choice of the valve prosthesis in mitral valve replacement (MVR) for infective endocarditis (IE) is controversial and challenging, particularly for younger patients. Hypothesis: The postoperative outcomes of mechanical and biological MVR in IE patients aged 50 to 69 years are different. Methods: All IE patients aged 50 to 69 years with primary MVR in Hubei province hospitals from 2002 to 2018 were retrospectively reviewed. The median duration of follow-up was 8.7 years (IQR, 6.8-10.9 years). Propensity score matching (1:3 ratio) was used to yield 492 patients with comparable baseline features between bioprostheses and mechanical prosthetic valve groups. Outcomes were postoperative mid-to long-term survival, mitral valve reoperation, prosthetic valve endocarditis (PVE), stroke, and major bleeding events. Results: Fifteen-year survival after MVR was 80.6% in the mechanical valve group and 69.3% in the bioprostheses group (HR 0.545, P = .040). The cumulative incidence of mitral valve reoperation was 8.8% with mechanical valves and 21.4% with bioprostheses (HR 0.260, P = .002). The cumulative incidence of PVE was 5.6% with mechanical valves and 7.2% with bioprostheses (HR 0.629, P = .435). The cumulative incidence of stroke was 12.9% with mechanical valves and 10.5% with bioprostheses (HR 1.217, P = .647). The cumulative incidence of major bleeding was 12.0% with mechanical valves and 6.75% with bioprostheses (HR 1.579, P = .268). Conclusions: Mechanical valve prostheses were associated with better survival, lower rates of reoperation compared with bioprostheses within 15 years after MVR in IE patients aged 50 to 69. These findings suggest mechanical valve prostheses may be a more reasonable alternative to bioprostheses in this patient group.

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Section: Introductionmentioning

confidence: 99%

Bioprosthetic vs mechanical mitral valve replacement for infective endocarditis in patients aged 50 to 69 years

Jiang

Xie

et al. 2020

Clinical Cardiology

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“…Biological or mechanical prostheses could be implanted with good results. Toyoda et al reported similar survival rate and incidence of re-operation at 12 years using both mechanical and biological prostheses in aortic and mitral position (20) . However, valve repair when feasible, particularly in mitral position, was associated with better long-term results (21) .…”

Section: Contemporary Surgery For Endocarditismentioning

confidence: 85%

Contemporary Surgery in Infective Endocarditis

Morjan¹,

Hemelrijck²,

Mestres³

2019

ejcm

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Infective endocarditis is an uncommon disease but still carries high morbidity and mortality. The management of the patient with infective endocarditis changed over the last years with improvement of diagnostic tools and early aggressive medical and surgical treatment. The multidisciplinary approach is an accepted standard of practice and approximately 40-50% of patients discussed in endocarditis teams undergoes surgery. Timing of surgery remains a debated issue, while complexity of surgery remains a characteristic of this pathology. Although isolated native valve endocarditis remains associated with acceptable morbidity and mortality, the same still high in the setting of multiple valve surgery and prosthetic infections.

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“…Toyoda et al [ 8 ] investigated recurrent infections in patients undergoing mechanical or tissue valve replacement in the setting of endocarditis, failing to demonstrate any significant difference, with similar survival and freedom from endocarditis recurrence (9.4% vs . 10.0%, adjusted Cox P =0.81 after aortic valve replacement in 12 years).…”

Section: Discussionmentioning

confidence: 99%

“…The debate about prosthesis choice in this setting has been ongoing and is dependent on several factors influencing long-term performance. Homografts are recommended by the international guidelines [ 2 ] , stentless valves have proven their efficacy in smaller case series with excellent long-term results [ 5 , 6 ] , and conventional stented valves are a further option in the armamentarium of surgical procedures for valve endocarditis [ 7 , 8 ] .…”

Section: Introductionmentioning

confidence: 99%

Stentless Root Replacement versus Tissue Valves in Infective Endocarditis – A Propensity-Score Matched Study

Easo¹,

Szczechowicz²,

Hölzl³

et al. 2020

Braz J Cardiovasc Surg

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Introduction People with aortic/prosthetic valve endocarditis are a high-risk cohort of patients who present a challenge for all medically involved disciplines and who can be treated by various surgical techniques. Methods We analyzed the results of treatment of root endocarditis with Medtronic Freestyle® in full-root technique over 19 years (1999-2018) and compared them against treatment with other tissue valves. Comparison was made with propensity score matching, using the nearest neighbor method. Various tests were performed as suited for adequate analyses. Results Fifty-four patients in the Medtronic Freestyle group (FS group) were matched against 54 complex root endocarditis patients treated with other tissue valves (Tissue group). Hospital mortality was 9/54 (16.7%) in the FS group vs . 14/54 (25.6%) in the Tissue group ( P =0.24). Cox regression performed for early results demonstrated coronary heart disease ( P =0.004, odds ratio 2.3), among others, influencing early mortality. Recurrent infection was low (1.8% for FS and Tissue patients) and freedom from reoperation was 97.2% at a total of 367 patient-years of follow-up (median of 2.7 years). Conclusion The stentless xenograft is a viable alternative for treatment of valve/root/prosthetic endocarditis, demonstrating a low rate of reinfection. The design of the bioroot allows for complex reconstructive procedures at the outflow tract and the annular level with at an acceptable operative risk. Endocarditis patients can be treated excluding infective tissue from the bloodstream, possibly with benefits, concerning bacteremia and recurrent infection. Furthermore, the use of the stentless bioroot offers varying treatment options in case of future valve degeneration.

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Bioprosthetic Versus Mechanical Valve Replacement for Infective Endocarditis: Focus on Recurrence Rates

Abstract: Bioprosthetic and mechanical valves are associated with similar survival and freedom from endocarditis recurrence. These data support guideline recommendations that patient factors guide prosthesis choice in infective endocarditis.

Cited by 43 publications

References 26 publications

Bioprosthetic vs mechanical mitral valve replacement for infective endocarditis in patients aged 50 to 69 years

Bioprosthetic vs mechanical mitral valve replacement for infective endocarditis in patients aged 50 to 69 years

Contemporary Surgery in Infective Endocarditis

Stentless Root Replacement versus Tissue Valves in Infective Endocarditis – A Propensity-Score Matched Study

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