Treatment of endocarditis with valve replacement: the question of tissue versus mechanical prosthesis

Moon, Marc R.; Miller, D. Craig; Moore, Kathleen A.; Oyer, P E; Mitchell, R. Scott; Robbins, Robert C.; Stinson, Edward B.; Shumway, Norman E.; Reitz, Bruce A.

doi:10.1016/s0003-4975(00)02665-5

Cited by 178 publications

(135 citation statements)

References 17 publications

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“…[19,20] In a recent, retrospective study of patients on dialysis with IE who underwent valve surgery, no difference in longer term mortality was evident between type of valve prosthesis.…”

Section: Discussionmentioning

confidence: 99%

“…[18] Other studies have found no significant difference in mortality for biologic compared to mechanical valve replacement, but a higher rate of reoperation in younger patients who received biologic prosthesis. [19,20] In a recent, retrospective study of patients on dialysis with IE who underwent valve surgery, no difference in longer term mortality was evident between type of valve prosthesis. [21] However, this cohort included patients treated with surgery beyond the acute phase of IE and the very high one-year mortality rate may have overshadowed any valve-related effect.…”

Section: Accepted M Manuscriptmentioning

confidence: 99%

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One-year outcome following biological or mechanical valve replacement for infective endocarditis

Delahaye

Chu

Altclas

et al. 2015

International Journal of Cardiology

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Structured abstract BackgroundNearly half of patients require cardiac surgery during the acute phase of infective endocarditis (IE). We describe the characteristics of patients according to the type of valve replacement (mechanical or biological), and examine whether the type of prosthesis was associated with in-hospital and 1-year mortality. Methods and Results Among 5,591 patients included in the International Collaboration on Endocarditis ProspectiveCohort Study, 1,467 patients with definite IE were operated on during the active phase and had a biological (37%) or mechanical (63%) valve replacement.Patients who received bioprostheses were older (62 vs 54 years), more often had a history of cancer (9% vs 6%), and had moderate or severe renal disease (9% vs 4%); proportion of health care-associated IE was higher (26% vs 17%); intracardiac abscesses were more frequent (30% vs 23%). In-hospital and 1-year death rates were higher in the bioprosthesis group, 20.5% vs 14.0% (p=0.0009) and 25.3% vs 16.6% (p<.0001), respectively.In multivariable analysis, mechanical prostheses were less commonly implanted in older patients (odds ratio: 0.64 for every 10 years), and in patients with a history of cancer (0.72), but were more commonly implanted in mitral position (1.60).Bioprosthesis was independently associated with 1-year mortality (hazard ratio: 1.298). ConclusionsPatients with IE who receive a biologic valve replacement have significant differences in clinical characteristics compared to patients who receive a mechanical prosthesis. Biologic valve replacement is independently associated with a higher in-hospital and 1-year mortality, a result which is possibly related to patient characteristics rather than valve dysfunction. There are limited data to support the choice of either type of prosthesis in IE. A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPT[6] The characteristics of patients receiving biological or mechanical prosthesis and the association between type of valve prosthesis and outcome are not clearly defined. Thus, the objectives of this observational study were to describe the characteristics of patients according to the type of prosthesis and to examine the relationship between prosthesis type and 1-year mortality. METHODS International Collaboration on Endocarditis -Prospective Cohort StudyA C C E P T E D M A N U S C R I P T Medicine. All patients from sites meeting criteria for participation were included in ICE-PCS. ACCEPTED MANUSCRIPTSites had to meet the following criteria: (1) minimum enrolment of 12 cases per year in a centre with access to cardiac surgery; (2) patient identification procedures in place to ensure consecutive enrolment and to minimize ascertainment bias; (3) high-quality data, including query resolution; and (4) institutional review board and/or ethics committee approval or waiver based on local standards. Patient Selection, Data Collection and OutcomesPatients were identified prospectively and consecutively enrolled in ICE-PCS if they met criteria for possible or definite I...

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“…[19,20] In a recent, retrospective study of patients on dialysis with IE who underwent valve surgery, no difference in longer term mortality was evident between type of valve prosthesis.…”

Section: Discussionmentioning

confidence: 99%

Section: Accepted M Manuscriptmentioning

confidence: 99%

One-year outcome following biological or mechanical valve replacement for infective endocarditis

Delahaye

Chu

Altclas

et al. 2015

International Journal of Cardiology

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“…There was no significant difference in endocarditis rates between mechanical (1.2%) and bioprosthetic (1.8%) valve substitutes. Operative mortality and complication-free survival were also similar within the two valve types [28].…”

Section: Infective Endocarditismentioning

confidence: 65%

“…There are conflicting data of accelerated deterioration of prosthetic heart valves during pregnancy [28]. However, in this very young age group, even without accelerated deterioration by pregnancy, the durability of bioprostheses is limited [3,20].…”

Section: Valve Choice In Women Of Child-bearing Agementioning

confidence: 99%

Mechanical versus biological aortic valve replacement strategies

Reineke

Gisler

Englberger

et al. 2016

Expert Review of Cardiovascular Therapy

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Aortic valve replacement (AVR) is the most frequently performed procedure in valve surgery.The controversy about the optimal choice of the prosthetic valve is as old as the technique itself. Currently there is no perfect valve substitute available. The main challenge is to choose between mechanical and biological prosthetic valves. Biological valves include pericardial (bovine, porcine or equine) and native porcine bioprostheses designed in stented or stentless versions. Homografts and pulmonary autografts are reserved for special indications and will not be discussed in detail in this review. We will focus on the decision making between artificial biological and mechanical prostheses, respectively.The first part of this article reviews guideline recommendations concerning the choice of aortic prostheses in different clinical situations while the second part is focused on novel strategies in the treatment of patients with aortic valve pathology.Keywords: aortic valve replacement, biological valve prosthesis, mechanical valve prosthesis, oral anticoagulation, novel oral anticoagulants. Current EvidenceThe current guidelines of the European Society of Cardiology from 2012 [1] and of the American Heart Association from 2014 [2] uniformly recommend mechanical aortic valve replacement (AVR) in patients under 60 years of age and biologic AVR in patients over 70 years of age (Fig. 1). In patients between 60 and 70 years of age, recommendations are conflicting. The ESC-Guidelines recommend biologic prosthesis from the age of 65 years onwards, whereas the newer AHA/ACC guidelines only recommend biological valves starting with 70 years of age. Looking at the development of the guidelines over the last 20 years there is a shift away from a clear-cut age limit towards the patients wish and life-style considerations.Currently there is a trend towards more biological AVR, also in patients under 65 years of age, which is contrary to the progress of life expectancy of patients at this age.Justification for this approach is the option for a valve-in-valve procedure in the case of structural valve deterioration (SVD) which might become a routine bail out strategy. In addition, the last generation of pericardial tissue valves may have excellent long-term durability over 20 years. However, current studies also demonstrate a significant age-

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“…Moon et al compared mechanical valves with bioprostheses, and also concluded that freedom from reoperation was independent of valve type and that selection of a prosthetic valve should be determined according to age. 21 Some investigators have reported the superiority of allografts for aortic root endocarditis because of their resistance to infection and technical advantages (more flexibility and pliability). The recurrence rate was 5% and 10% in the reports from McGiffin et al 14 and Hydock et al 22 In Japan, allografts are hard to obtain for ethical reasons and lack of infrastructure, although this is under development.…”

Section: Selection Of Prosthetic Valvementioning

confidence: 99%

Active Infective Endocarditis Management and Risk Analysis of Hospital Death From 24 Years' Experience

Hanai

Hara

Mashiko

et al. 2008

Circ J

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Treatment of endocarditis with valve replacement: the question of tissue versus mechanical prosthesis

Cited by 178 publications

References 17 publications

One-year outcome following biological or mechanical valve replacement for infective endocarditis

One-year outcome following biological or mechanical valve replacement for infective endocarditis

Mechanical versus biological aortic valve replacement strategies

Active Infective Endocarditis Management and Risk Analysis of Hospital Death From 24 Years' Experience

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