Key result
Mechanical valves compared to bioprostheses increased bleeding risk at 11 years (RR 1.6; 95% CI 1.2-2.2; P<0.001) but had lower reoperation risk, with no significant difference in survival.
Why the study?
Do mechanical valves compared to bioprostheses improve survival or alter the risk of bleeding, reoperation, and endocarditis in patients requiring valve replacement?
Meta-Analysis (n=1,229)
Do mechanical valves compared to bioprostheses improve survival or alter the risk of bleeding, reoperation, and endocarditis in patients requiring valve replacement?
Answers are grounded in this paper and cite their sources.
In a meta-analysis of 3 RCTs, mechanical valves and bioprostheses showed similar survival, but mechanical valves had higher bleeding and endocarditis risks while bioprostheses had higher reoperation rates.
The main purpose of this meta-analysis was to compare the outcomes of patients who randomly received mechanical valves or bioprosthesis, over a long-term clinical follow-up. We found only three trials meeting our selection criteria with a total of 1229 patients (8069. 5 patient-yr). Bleeding was more frequent in patients with mechanical prostheses both after 5 yr (RR=2.6; IC=[1.9;3.5]; P<0.0001) and 11 yr (RR=1.6; IC=[1.2;2.2]; P<0.001) of follow-up. However, the increased risk of bleeding at 11 yr was only statistically significant with mechanical prostheses in the aortic position (RR=1.93; IC=[1.36;2. 74]; P=0.0002). Reoperation was significantly more frequent in patients with bioprosthesis after 11 yr follow-up (RR=0.4; IC=[0.3;0. 6]; P<0.001). Endocarditis was more frequent after 11 yr (RR=0.6; IC=[0.3;0.95]; P<0.05) in patients with mechanical prostheses but these results were heterogeneous between mitral and aortic valves. The choice of valve type does not significantly influence survival.
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Behrouz Kassaï (2000) conducted a meta-analysis in Valvular heart disease requiring replacement (n=1,229). Mechanical valves vs. Bioprosthesis was evaluated on Bleeding at 11 years (RR 1.6, 95% CI 1.2-2.2, p=<0.001). Mechanical valves compared to bioprostheses increased bleeding risk at 11 years (RR 1.6; 95% CI 1.2-2.2; P<0.001) but had lower reoperation risk, with no significant difference in survival.
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