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The long-term outcome of biological or mechanical prostheses for heart valve surgery: a meta-analysis of randomised clinical studies

2013; Oxford University Press; Volume: 34; Issue: suppl 1 Linguagem: Inglês

10.1093/eurheartj/eht308.p2132

1522-9645

Alberto Takeshi Kiyose, Érica Aranha Suzumura, Lígia Nasi Laranjeira, Anna Maria Buehler, José Amalth Espírito Santo, Alexandre Biasi Cavalcanti, Otávio Berwanger, Antônio Carlos Carvalho, A. A. V. P. Paola, Valdir Ambrósio Moisés,

Infective Endocarditis Diagnosis and Management

Background: The choice of a mechanical (MP) or biological prostheses (BP) is still not a consensus for patients with heart valve disease. Both prostheses have advantages and limitations depending on the age and clinical situation. The aim of this study was to determine the long-term results of MP or BP. Methods: The methods included a systematic review of the following electronic databases Medline/Pubmed, Central-Cochrane Library, Embase/Elsevier, Scopus, Web of Science, and Lilacs which were conducted by independent researchers. Other journals and manuscript sources were also consulted. The following outcomes were analysed: bleeding, infective endocarditis, valve failure, thromboembolism, valve thrombosis, nonstructural dysfunction, re-operation and mortality rate. We assessed and quantified statistical heterogeneity using Cochran's Q test and the I2 statistic. An analysis for the binary outcomes was performed using the Mantel-Haenszel fixed effect models, or Der Simonian and Laird for random effect models when heterogeneity was observed. We calculated the risk ratios (RR) with 95% confidence intervals (95% CIs). An assessment for publication bias was performed using Egger's linear regression test. Two-sided p-values < 0.05 were considered statistically significant. Results: A total of 6,286 references were identified; 19 were analysed and four were included in qualitative analysis and meta-analysis. In total 1,528 patients formed the basis for meta-analysis. No significant difference was found in the total mortality rate between BP and MP in a follow-up period of 20 years (RR=1.05; CI95%:0.97-1.14; p=0.046). The risk of endocarditis (RR=1.44; CI95%: 1.09-1.90), nonstructural dysfunction (RR=11.78; CI95%: 5.11-27.17) and re-operations (RR=3.60; CI95%: 2.51-5.17) were higher for patients with BP; however, paravalvular leak (RR=0.45; CI95%:0.24-0.85) was higher in patients with MP. There were no statistically significant difference between either BP or MP patients for valve thrombosis (RR=0.66; CI95%:0.11-3.91), thromboembolism (RR=1.16; CI95%: 0.82-1.64) or bleeding (RR=0.76; CI95%: 0.54-1.07). Conclusions: This meta-analysis did not show any differences in long-term mortality rates, thromboembolic events, or hemorrhage between BP and MP patients after 20 years of follow-up. However, MP was associated with lower risks of all other outcomes, except paravalvular leak.