Key result
Surgical management of aortic valve infective endocarditis with homografts resulted in similar long-term all-cause mortality compared to conventional prostheses (IRR 1.03; 95% CI 0.81-1.31; P=0.83).
Why the study?
Does cryopreserved homograft improve survival or reduce recurrent endocarditis and reoperation compared to conventional prosthesis in patients with aortic valve infective endocarditis?
Systematic Review (n=2,232)
Does cryopreserved homograft improve survival or reduce recurrent endocarditis and reoperation compared to conventional prosthesis in patients with aortic valve infective endocarditis?
Relative Risk: 1.03 (95% CI 0.81–1.31)
p-value: p=0.83
Homografts and conventional prostheses offer similar survival and freedom from recurrent endocarditis and reoperation for aortic valve infective endocarditis, though homografts may have a higher reoperation risk compared specifically to mechanical valves.
No long-term mortality benefit with homografts versus conventional prostheses in aortic valve IE; confirms equivalence and supports individualized valve selection.
OBJECTIVE: Surgical management of aortic valve infective endocarditis (IE) with cryopreserved homograft has been associated with lower risk of recurrent IE, but there is equipoise with regard to the optimal prosthesis. This systematic review and meta-analysis were performed to compare outcomes between homograft and conventional prosthesis for aortic valve IE. METHODS: We searched MEDLINE database to September 2017 for studies comparing homograft versus conventional prosthesis. The main outcomes were all-cause mortality, recurrent IE, and reoperation. RESULTS: There were 18 included comparative observational studies with 2232 patients (median follow up = 5 [interquartile range: 2-7] years, 30% prosthetic valve endocarditis); four studies were adjusted for baseline differences. There were no differences in perioperative mortality or stroke despite a greater proportion of staphylococcal endocarditis, abscess, and root replacements but less multivalve involvement in the homograft group. Long-term outcomes of all-cause mortality [incidence rate ratio (IRR) = 1.03, 95% confidence interval (CI) = 0.81-1.31, P = 0 .83, for unmatched, and IRR = 0.82, 95% CI = 0.36-1.84, P = 0.63, for matched studies], recurrent endocarditis (IRR = 1.01, 95% CI = 0.53-1.93, P = 0.96, for unmatched, and IRR = 1.04, 95% CI = 0.49-2.19, P = 0.92, for matched studies), and reoperation (IRR = 1.60, 95% CI = 0.80-3.21, P = 0.18, for unmatched, and IRR = 3.17, 95% CI = 0.52-19.44, P = 0.21, for matched studies) were not different comparing homograft versus conventional prosthesis. There was a significantly increased need for reoperation with homograft versus mechanical prosthetic valves, but this comparison was based on limited data. CONCLUSIONS: Homografts and conventional prostheses offer similar survival and freedom from recurrent endocarditis and reoperation for aortic valve IE. Homografts may be associated with greater risk of reoperation compared with mechanical valves.
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Yanagawa et al. (2018) conducted a systematic review in Aortic valve infective endocarditis (n=2,232). Homograft vs. Conventional prosthesis was evaluated on All-cause mortality (IRR 1.03, 95% CI 0.81-1.31, p=0.83). Surgical management of aortic valve infective endocarditis with homografts resulted in similar long-term all-cause mortality compared to conventional prostheses (IRR 1.03; 95% CI 0.81-1.31; P=0.83).
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