Mechanical valves compared to bioprostheses increased bleeding risk at 11 years (RR 1.6; 95% CI 1.2-2.2; P<0.001) but had lower reoperation risk, with no significant difference in survival.
Meta-Analysis (n=1,229)
Do mechanical valves compared to bioprostheses improve survival or alter the risk of bleeding, reoperation, and endocarditis in patients requiring valve replacement?
In a meta-analysis of 3 RCTs, mechanical valves and bioprostheses showed similar survival, but mechanical valves had higher bleeding and endocarditis risks while bioprostheses had higher reoperation rates.
Effect estimate: RR 1.6 (95% CI 1.2-2.2)
p-value: p=<0.001
The main purpose of this meta-analysis was to compare the outcomes of patients who randomly received mechanical valves or bioprosthesis, over a long-term clinical follow-up. We found only three trials meeting our selection criteria with a total of 1229 patients (8069. 5 patient-yr). Bleeding was more frequent in patients with mechanical prostheses both after 5 yr (RR=2.6; IC=1.9;3.5; P<0.0001) and 11 yr (RR=1.6; IC=1.2;2.2; P<0.001) of follow-up. However, the increased risk of bleeding at 11 yr was only statistically significant with mechanical prostheses in the aortic position (RR=1.93; IC=1.36;2. 74; P=0.0002). Reoperation was significantly more frequent in patients with bioprosthesis after 11 yr follow-up (RR=0.4; IC=0.3;0. 6; P<0.001). Endocarditis was more frequent after 11 yr (RR=0.6; IC=0.3;0.95; P<0.05) in patients with mechanical prostheses but these results were heterogeneous between mitral and aortic valves. The choice of valve type does not significantly influence survival.
Behrouz Kassaï (Sun,) conducted a meta-analysis in Valvular heart disease requiring replacement (n=1,229). Mechanical valves vs. Bioprosthesis was evaluated on Bleeding at 11 years (RR 1.6, 95% CI 1.2-2.2, p=<0.001). Mechanical valves compared to bioprostheses increased bleeding risk at 11 years (RR 1.6; 95% CI 1.2-2.2; P<0.001) but had lower reoperation risk, with no significant difference in survival.