Key result
Mechanical valves were associated with worse early mortality and no 5-year survival advantage compared to bioprosthetic valves in patients >65 years old with left-sided infective endocarditis.
Why the study?
Outcomes comparing bioprosthetic versus mechanical prosthesis choice for aortic valve and mitral valve infective endocarditis in patients >65 years old were not well established.
Does mechanical valve replacement improve 5-year overall survival compared to bioprosthetic valve replacement in patients >65 years old with left-sided infective endocarditis?
Cohort
Yes
Does mechanical valve replacement improve 5-year overall survival compared to bioprosthetic valve replacement in patients >65 years old with left-sided infective endocarditis?
In Medicare patients >65 years old with left-sided infective endocarditis, mechanical valves offer no 5-year survival advantage over bioprosthetic valves and are associated with worse early mortality.
Answers are grounded in this paper and cite their sources.
May support bioprosthetic preference to mitigate early mortality in elderly left-sided IE; leaves open need for randomized confirmation.
Objective: To compare the outcomes between bioprosthetic and mechanical prosthesis choice for aortic valve and mitral valve infective endocarditis (IE) in patients >65 years old. Methods: Medicare Provider Analysis and Review files from 2011 to 2019 were queried for adult patients >65 years old with de novo IE who underwent isolated bioprosthetic aortic valve replacement (bAVR), mechanical aortic valve replacement (mAVR), bioprosthetic mitral valve replacement (bMVR), or mechanical mitral valve replacement (mMVR). Patients with preoperative ischemic or hemorrhagic stroke were excluded. Analyses were conducted separately for the aortic and mitral position: bAVR versus mAVR, and bMVR versus mMVR. Propensity score matching was used to account for measured confounders. The primary outcome was 5-year overall survival analyzed using restricted mean survival time; secondary outcomes were the 5-year cumulative incidences of valve reoperation, heart failure readmission, recurrent IE, bleeding, and ischemic stroke analyzed using Fine-Gray regression with death as a competing risk. There were no significant differences in the cumulative incidences of secondary outcomes. Conclusions: This analysis of patients >65 years old with left-sided IE demonstrated that mechanical valves were associated with worse early mortality, no 5-year survival advantage over bioprosthetic valves, and provide no benefit in this population.
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Lutfi et al. (2025) conducted a cohort in Left-sided infective endocarditis. Mechanical valve prosthesis vs. Bioprosthetic valve prosthesis was evaluated on 5-year overall survival (p== .451). Mechanical valves were associated with worse early mortality and no 5-year survival advantage compared to bioprosthetic valves in patients >65 years old with left-sided infective endocarditis.
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