Campbell D Flynn1, Neil P Curran1, Stephanie Chan1, Isabel Zegri-Reiriz2, Manel Tauron3, David H Tian4, Gosta B Pettersson5, Joseph S Coselli6,7, Martin Misfeld8, Manuel J Antunes9, Carlos A Mestres10,11, Eduard Quintana12. 1. Department of Cardiothoracic Surgery, St George Hospital, Sydney, Australia. 2. Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Santa Pau, Barcelona, Spain. 3. Cardiac Surgery Department, Hospital de la Santa Creu i Santa Pau, Barcelona, Spain. 4. Collaborative Research Group, Macquarie University, Sydney, Australia. 5. Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA. 6. Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, TX, USA. 7. Texas Heart Institute, Houston, TX, USA. 8. University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany. 9. Clinic of Cardiothoracic Surgery, University of Coimbra Medical School, Coimbra, Portugal. 10. Department of Cardiac Surgery, University Hospital Zürich, Zürich, Switzerland. 11. Department of Cardiothoracic Surgery, The University of the Free State, Bloemfontein, South Africa. 12. Department of Cardiovascular Surgery, Hospital Clinic, University of Barcelona, Barcelona, Spain.
Abstract
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. 2019 Annals of Cardiothoracic Surgery. All rights reserved.
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. 2019 Annals of Cardiothoracic Surgery. All rights reserved.
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