Mechanical mitral valve replacement in patients <70 years was associated with lower long-term mortality (HR 0.81; 95% CI 0.71-0.92; P=0.002) and reoperation risk, but higher bleeding risk than bioMVR.
Meta-Analysis (n=20,219)
Does bileaflet mechanical mitral valve replacement reduce mortality and reoperation compared to bioprosthesis mitral valve replacement in patients aged less than 70 years?
In patients <70 years undergoing mitral valve replacement, mechanical valves are associated with lower mortality and reoperation rates but higher bleeding risk compared to bioprosthetic valves.
Effect estimate: HR 0.81 (95% CI 0.71-0.92)
p-value: p=0.002
BACKGROUND: The optimal mitral prosthesis in young patients is unclear. This systematic review and meta-analysis were performed to compare outcomes between bileaflet mechanical mitral valve replacement (mMVR) and bioprosthesis mitral valve replacement (bioMVR) for MVR patients aged less than 70 years. METHODS: We searched MEDLINE and EMBASE databases from inception to July 2018 for studies comparing surgical outcomes of mMVR vs bioMVR. RESULTS: There were 14 observational studies with 20 219 patients (n = 14 658 mMVR and n = 5561 bioMVR). Patients receiving an mMVR were younger with fewer comorbidities including renal failure, dialysis, and less-infective endocarditis (P < .001). The estimated 10-year mortality ranged from 19% to 49% for mMVR and 22% to 58% for bioMVR among studies. Comparing matched or adjusted data, mMVR was associated with lower operative (risk ratio RR: 0.61; 95% confidence interval CI: 0.39, 0.94; P = .03) and long-term (HR: 0.81; 95% CI: 0.71, 0.92; P = .002) mortality at a median follow-up of 8 years (IQR: 6-10 years). Estimated 10-year risk for mitral valve reoperation ranged from 0% to 8% for mMVR and 8% to 22% for bioMVR among matched/adjusted studies. mMVR was associated with lower matched/adjusted risk of reoperation (HR: 0.35; 95% CI: 0.19, 0.65; P = .001) but with greater risk of bleeding (HR: 1.59; 95% CI: 1.19, 2.13; P = .002) and a trend to greater risk of stroke and embolism (HR: 1.70; 95% CI: 0.92, 3.15; P = .09). CONCLUSION: Mechanical MVR in patients aged less than 70 years is associated with a lower risk of operative mortality as well as a 20% lower risk of long-term death and 65% lower risk of mitral valve reoperation but 60% greater risk of bleeding compared with bioMVR in matched or adjusted data.
Yanagawa et al. (Mon,) conducted a meta-analysis in Mitral valve replacement (n=20,219). Bileaflet mechanical mitral valve replacement (mMVR) vs. Bioprosthesis mitral valve replacement (bioMVR) was evaluated on Long-term mortality (HR 0.81, 95% CI 0.71-0.92, p=0.002). Mechanical mitral valve replacement in patients <70 years was associated with lower long-term mortality (HR 0.81; 95% CI 0.71-0.92; P=0.002) and reoperation risk, but higher bleeding risk than bioMVR.