Key result
Mechanical AVR linked to ~45% lower long-term mortality vs bioprosthetic valves in middle-aged patients.
Why the study?
Whether the type of prosthesis implanted for aortic valve replacement for infective endocarditis impacts patient survival is a matter of debate.
Does mechanical aortic valve replacement improve long-term survival and reduce recurrence of endocarditis compared to biological aortic valve replacement in patients aged 40 to 65 years with infective endocarditis?
Observational (n=549)
Yes
Does mechanical aortic valve replacement improve long-term survival and reduce recurrence of endocarditis compared to biological aortic valve replacement in patients aged 40 to 65 years with infective endocarditis?
In middle-aged patients (40-65 years) undergoing aortic valve replacement for infective endocarditis, mechanical prostheses were associated with significantly better long-term survival and lower rates of recurrent endocarditis compared to biological prostheses.
Answers are grounded in this paper and cite their sources.
Mechanical valves linked to better outcomes in this cohort; leaves open confirmation by RCTs before guiding prosthesis choice in middle-aged IE.
Background: Infective endocarditis (IE) is a serious disease, and in many cases, surgery is necessary. Whether the type of prosthesis implanted for aortic valve replacement (AVR) for IE impacts patient survival is a matter of debate. The aim of the present study is to quantify differences in long-term survival and recurrence of endocarditis AVR for IE according to prosthesis type among patients aged 40 to 65 years. Methods: This was an analysis of the INFECT-REGISTRY. Trends in proportion to the use of mechanical prostheses versus biological ones over time were tested by applying the sieve bootstrapped t-test. Confounders were adjusted using the optimal full-matching propensity score. The difference in overall survival was compared using the Cox model, whereas the differences in recurrence of endocarditis were evaluated using the Gray test. Results: Overall, 4365 patients were diagnosed and operated on for IE from 2000 to 2021. Of these, 549, aged between 40 and 65 years, underwent AVR. A total of 268 (48.8%) received mechanical prostheses, and 281 (51.2%) received biological ones. A significant trend in the reduction of implantation of mechanical vs. biological prostheses was observed during the study period (p < 0.0001). Long-term survival was significantly higher among patients receiving a mechanical prosthesis than those receiving a biological prosthesis (hazard ratio [HR] 0.546, 95% CI: 0.322–0.926, p = 0.025). Mechanical prostheses were associated with significantly less recurrent endocarditis after AVR than biological prostheses (HR 0.268, 95%CI: 0.077–0.933, p = 0.039). Conclusions: The present analysis of the INFECT-REGISTRY shows increased survival and reduced recurrence of endocarditis after a mechanical aortic valve prosthesis implant for IE in middle-aged patients.
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Salsano et al. (2023) conducted an observational in Infective endocarditis requiring aortic valve replacement (n=549). Mechanical aortic valve prosthesis vs. Biological aortic valve prosthesis was evaluated on Long-term mortality (HR 0.546, 95% CI 0.322-0.926, p=0.025). Mechanical aortic valve replacement was associated with lower long-term mortality and reduced recurrence of endocarditis compared to biological valves in middle-aged patients.
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