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

Jun Yu; En Qiao; Wei Wang

doi:10.1002/clc.23854

June 5, 2022Clinical CardiologyOpen Access

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

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Why the study?

Either a mechanical or bioprosthetic valve is used in patients undergoing mitral valve replacement, but the optimal mitral prosthesis remains controversial.

Does mechanical mitral valve replacement reduce long-term mortality compared to bioprosthetic mitral valve replacement in patients undergoing MVR?

Structured PICO

Does mechanical mitral valve replacement reduce long-term mortality compared to bioprosthetic mitral valve replacement in patients undergoing MVR?

P

Population

35,903 patients undergoing mitral valve replacement (MVR) pooled from 22 studies

I

Intervention

Mechanical mitral valve replacement (MVRm) (n = 23,868)

C

Comparator

Bioprosthetic mitral valve replacement (MVRb) (n = 12,035)

O

Outcome

Long-term all-cause mortalityhard clinical

Mechanical mitral valve replacement is associated with lower long-term mortality and reoperation risk but higher risks of bleeding and stroke compared to bioprosthetic valves, with consistent findings in patients under 70 years old.

Implication

Mechanical mitral valves reduce long-term mortality and reoperations versus bioprosthetic; confirms durability benefit despite bleeding and embolic risks in meta-analysis.

Abstract

Either a mechanical or bioprosthetic valve is used in patients undergoing mitral valve replacement (MVR). However, the optimal mitral prosthesis remains controversial. The aim of this meta-analysis was thus to compare outcomes between mechanical mitral valve replacement (MVRm) and bioprosthetic mitral valve replacement (MVRb) for MVR patients. We searched Embase, PubMed, Web of Science, and Cochrane Library databases from January 1, 2000 to October 31, 2021 for studies that directly compared surgical outcomes of MVRm and MVRb. A total of 22 studies with 35 903 patients were included in the meta-analysis (n = 23 868 MVRm and n = 12 035 MVRb). The MVRm group displayed lower long-term all causes mortality (HR, 0.84; 95% confidence interval [CI]: 0.77-0.91; p < .0001; I² = 51%), and fewer mitral reoperation (hazard ratio [HR]: 0.34; 95% CI: 0.23-0.50; p < .00001; I² = 74%) than MVRb group. However, the MVRm group was associated with a greater risk of major bleeding events (HR: 1.21; 95% CI: 1.14-1.29; p < .00001; I² = 0%), stroke and systemic embolism (HR: 1.20; 95% CI: 1.10-1.32; p < .0001; I² = 0%) in matched or adjusted data. No significant difference was observed between MVRm and MVRb on operative mortality in matched/adjusted group (risk ratios: 0.83; 95% CI: 0.66-1.05; p = .12; I² = 0%). The results were consistent with patients aged under 70 years old. Patients who received a MVRm is associated with 16% lower risk of long-term mortality and 66% lower risk of mitral reoperation, but 20% greater risk of stroke or systemic embolism, 21% greater risk of major bleeding compared with MVRb in matched/adjusted studies group, which were consistent to patients younger than the age of 70 years who underwent MVR.