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

Abstract

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.

Bioprosthetic vs. Mechanical Mitral Valve Replacement for Rheumatic Heart Disease in Patients Aged 50–70 Years

“…A study analyzed patients aged 50–70 with infective endocarditis for mitral valve replacement, and the results showed that the long-term mortality and reoperation rates of the biological valve group were significantly higher than those of the mechanical valve group. There were no significant differences in stroke and major bleeding events ( 16 ). A retrospective study of patients with RHD from Taiwan showed that the all-cause mortality and reoperation rates in the biological valve group were higher than those in the mechanical valve group, no group differences were observed in the risks of stroke, thromboembolic events, and major bleeding events ( 7 ).…”

Mechanical or biologic prostheses for mitral valve replacement: A systematic review and meta‐analysis

“…The study selection process is summarized in Supporting Information: Figure 1 . Eventually, there were 22 studies 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 that met the eligibility criteria for meta‐analysis, one of which was nonrandomized prospective study 26 and 21 of which were retrospective cohort studies. The studies involved 35 903 patients ( n = 23 868 MVRm and n = 12 035 MVRb) who underwent MVR enrolled from 1969 to 2020.…”

“…Fourteen studies 8 , 10 , 13 , 14 , 15 , 19 , 21 , 23 , 24 , 25 , 29 , 30 , 31 , 32 in unmatched/unadjusted group and 14 studies 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 19 , 25 , 27 , 28 , 29 , 30 in matched/adjusted group documented details on long‐term mortality. The results indicated that patients in MVRm group exhibited a significant lower long‐term risk of death both in unmatched/unadjusted group (HR: 0.77; 95% CI: 0.70−0.84; p < .00001; I ² = 40%; Figure 2A ) and matched/adjusted group (HR: 0.84; 95% CI: 0.77−0.91; p < .0001; I ² = 51%; Figure 2A ).…”

“…Recent studies differ in their results. Kaneko et al 10 , Hu et al 11 , and Chen et al 12 favored mechanical mitral valve replacement (MVRm) over bioprosthetic mitral valve replacement (MVRb) for long‐term survival. Cetinkaya et al 13 , Cen et al 14 , and Bernard et al 15 suggested that the type of prosthesis did not influence on long‐term survival.…”

Open Transcatheter Multivalve Replacement in Degenerated Valve Prostheses in High-Risk Patients with Endocarditis

“…Choosing a biological valve prosthesis in younger patients carries the risk of rapid prosthesis degeneration and, eventually, high-risk re-operation [ 1 ] . In general, the guidelines do not recommend biological valve prostheses in patients under 65 years old [ 2 ] .…”