Can prosthesis type influence the recurrence of infective endocarditis after surgery for native valve endocarditis? A propensity weighted comparison

Abstract

OBJECTIVES Our goal was to investigate whether the incidence of valve-related adverse events might be different depending on the valve substitute after valve replacement for left-sided native valve endocarditis. METHODS We assessed the long-term freedom from recurrence, reoperation and survival of 395 patients who had valve replacements for native valve endocarditis (314 mechanical vs 81 biological). Age <18 years, reoperation, prosthetic endocarditis, right valve involvement, valve repair and homograft implants were the main exclusion criteria. The balance between the 2 groups was addressed by weighting the results on the inverse of the propensity score. RESULTS After inverse probability of treatment weighting (IPTW), freedom from recurrence of infective endocarditis was not significantly different (mechanical 84.1 ± 3.2% vs 50.6 ± 21.7%; P = 0.29) nor was freedom from reoperation different (mechanical 85.7 ± 3.1% vs biological 50.9 ± 21.9%; P = 0.29). Excluding competing deaths, patients receiving a bioprosthesis had a similar subdistribution hazard of the above end points compared to recipients of a mechanical valve [recurrence IPTW: hazard ratio (HR) 1.631, 95% confidence interval (CI) 0.756–3.516; P = 0.21; reoperation IPTW-HR 1.737, 95% CI 0.780–3.870; P = 0.18]. Mechanical valves were associated with improved long-term survival (34.9 ± 5.8% vs 10.5 ± 7.4% at 30 years; P = 0.0009; in particular: aortic valve subgroup 41.6 ± 9.3% vs 10.1 ± 8.2%; P < 0.0001), although the hazard of cardiovascular mortality did not favour either valve type (IPTW: HR 1.361, 95% CI 0.771–2.404; P = 0.29). CONCLUSIONS Our analysis showed a clinical trend in favour of mechanical valves as valve substitutes for native valve endocarditis, especially in the aortic position. In view of long-term freedom from adverse events, the choice of the valve type should be tailored according to patient characteristics and specific clinical conditions.

Long-Term Outcome of Mechanical and Biological Prostheses in Patients with Left-Side Infective Endocarditis: A Systematic Review and Meta-Analysis

“…The overall weighted mean age of patients who underwent surgery for infective endocarditis was 55.1 years (95% CI, 52.3-60.2) and was calculated from 11 studies reporting the mean age of all patients [19][20][21][22][23][24][26][27][28][29][30]. Eight studies [21,22,24,27,28,[30][31][32] reported the mean age of patients receiving either a MP or BP. In the mechanical group, the weighted mean age was 49.2 years (CI, 47.1-55.3), and in the biological group, the weighted mean age was 59.8 years (CI, 55.8-63.2).…”

“…In the mechanical group, the weighted mean age was 49.2 years (CI, 47.1-55.3), and in the biological group, the weighted mean age was 59.8 years (CI, 55.8-63.2). Twelve studies [20,21,[23][24][25][26][27][28][29][30][31][32] reporting on 8285 patients with infective endocarditis, including 4517 patients with MP and 3768 with BP, analyzed the overall long-term comparison between MP and BP, with a median follow-up ranging from 1 to 15.3 years (20,27). The longest follow-up was 20 years [20].…”

“…Seven studies presented data on early mortality [20,21,24,27,28,31,32] in 2815 patients, including 1590 with MP and 1225 with BP. The meta-analysis of the calculated OR did not reveal significant differences between the two groups (HR 1.08; 95% CI 0.63-1.85; p = 0.78).…”

“…Five studies [22,24,28,30,32] reported data on late prosthesis reinfection in 4491 patients, including 2433 in the mechanical group and 2058 in the biological group. The pooled analysis of the calculated HR did not reveal significant differences between the patients treated with a MP compared to those treated with a BP (HR 0.60; 95% CI 0.30-1.21; p = 0.15).…”

“…Five studies [20,24,[30][31][32] reported data on prosthesis reintervention in 4401 patients, including 2307 in the mechanical group and 2094 in the biological group. The meta-analysis of the calculated HR revealed a significant difference in favor of patients with MP compared to those treated with BP (HR 0.40; 95% CI 0.29-0.55; p < 0.0001), with the absence of heterogeneity (I2 = 0%; T2 = 0; p = 0.73; Figure 10).…”