Long-Term Outcome of Mechanical and Biological Prostheses in Patients with Left-Side Infective Endocarditis: A Systematic Review and Meta-Analysis
Background. Long-term outcomes of patients with infective endocarditis (IE) who received either a mechanical (MP) or biological prosthesis (BP) are conflicting. A meta-analysis of observational studies comparing the long-term outcomes of left-side IE with the use of MP versus BP was performed. Metho...
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MDPI AG
2021-09-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/10/19/4356 |
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| author | Francesco Formica Francesco Maestri Florida Gripshi Alan Gallingani Silvia Grossi Francesco Nicolini |
| author_facet | Francesco Formica Francesco Maestri Florida Gripshi Alan Gallingani Silvia Grossi Francesco Nicolini |
| author_sort | Francesco Formica |
| collection | DOAJ |
| description | Background. Long-term outcomes of patients with infective endocarditis (IE) who received either a mechanical (MP) or biological prosthesis (BP) are conflicting. A meta-analysis of observational studies comparing the long-term outcomes of left-side IE with the use of MP versus BP was performed. Methods. Electronic databases from January 2000 to June 2021 were screened. Studies reporting long-term mortality were analyzed. The primary endpoint was long-term overall mortality. Secondary endpoints were in-hospital/.30-day mortality and freedom from both prosthesis reinfection and reintervention. The pooled hazard ratio (HR) with 95% confidence interval (CI) was calculated for survival according to the random effect model. Results. Thirteen retrospective observational studies reporting on 8645 patients (MP: 4688; BP: 4137) were included for comparison. Twelve studies reported data of long-term survival for a total of 8285 patients (MP: 4517; BP: 3768). The pooled analysis revealed that the use of MP was statistically associated with longer benefits compared to BP (HR 0.74; 95% CI 0.63–0.86; <i>p</i> < 0.0001). The median follow-up time ranged from 1 to 15.3 years. The pooled analysis of five studies reporting data on prosthesis reinfection in 4491 patients (MP: 2433; BP: 2058) did not reveal significant differences (HR 0.60; 95% CI 0.30–1.21; <i>p</i> = 0.15). Five studies reported data on prosthesis reintervention in 4401 patients (MP: 2307; BP: 2094). The meta-analysis revealed a significant difference in favor of MP (HR 0.40; 95% CI 0.29–0.55; <i>p</i> < 0.0001). Meta-regression reported no effect of male gender (<i>p</i> = 0.09) and age (<i>p</i> = 0.77) on long-term survival. Conclusions. In a meta-analysis of retrospective observational studies comparing the long-term outcome of patients who underwent surgery for left-sided IE, the use of MP compared to BP is associated with a significant longer-term survival and with a reduced incidence of late reoperation. The incidence of late reinfection is comparable between the two prostheses. |
| first_indexed | 2024-03-10T06:58:10Z |
| format | Article |
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| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T06:58:10Z |
| publishDate | 2021-09-01 |
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| series | Journal of Clinical Medicine |
| spelling | doaj.art-a0ad92d6cb064fce83862d7d918050602023-11-22T16:18:14ZengMDPI AGJournal of Clinical Medicine2077-03832021-09-011019435610.3390/jcm10194356Long-Term Outcome of Mechanical and Biological Prostheses in Patients with Left-Side Infective Endocarditis: A Systematic Review and Meta-AnalysisFrancesco Formica0Francesco Maestri1Florida Gripshi2Alan Gallingani3Silvia Grossi4Francesco Nicolini5Department of Medicine and Surgery, University of Parma, 43126 Parma, ItalyCardiac Surgery Unit, University Hospital of Parma, 43126 Parma, ItalyCardiac Surgery Unit, University Hospital of Parma, 43126 Parma, ItalyCardiac Surgery Unit, University Hospital of Parma, 43126 Parma, ItalyDepartment of Anesthesia and Intensive Care, Parma University Hospital, 43126 Parma, ItalyDepartment of Medicine and Surgery, University of Parma, 43126 Parma, ItalyBackground. Long-term outcomes of patients with infective endocarditis (IE) who received either a mechanical (MP) or biological prosthesis (BP) are conflicting. A meta-analysis of observational studies comparing the long-term outcomes of left-side IE with the use of MP versus BP was performed. Methods. Electronic databases from January 2000 to June 2021 were screened. Studies reporting long-term mortality were analyzed. The primary endpoint was long-term overall mortality. Secondary endpoints were in-hospital/.30-day mortality and freedom from both prosthesis reinfection and reintervention. The pooled hazard ratio (HR) with 95% confidence interval (CI) was calculated for survival according to the random effect model. Results. Thirteen retrospective observational studies reporting on 8645 patients (MP: 4688; BP: 4137) were included for comparison. Twelve studies reported data of long-term survival for a total of 8285 patients (MP: 4517; BP: 3768). The pooled analysis revealed that the use of MP was statistically associated with longer benefits compared to BP (HR 0.74; 95% CI 0.63–0.86; <i>p</i> < 0.0001). The median follow-up time ranged from 1 to 15.3 years. The pooled analysis of five studies reporting data on prosthesis reinfection in 4491 patients (MP: 2433; BP: 2058) did not reveal significant differences (HR 0.60; 95% CI 0.30–1.21; <i>p</i> = 0.15). Five studies reported data on prosthesis reintervention in 4401 patients (MP: 2307; BP: 2094). The meta-analysis revealed a significant difference in favor of MP (HR 0.40; 95% CI 0.29–0.55; <i>p</i> < 0.0001). Meta-regression reported no effect of male gender (<i>p</i> = 0.09) and age (<i>p</i> = 0.77) on long-term survival. Conclusions. In a meta-analysis of retrospective observational studies comparing the long-term outcome of patients who underwent surgery for left-sided IE, the use of MP compared to BP is associated with a significant longer-term survival and with a reduced incidence of late reoperation. The incidence of late reinfection is comparable between the two prostheses.https://www.mdpi.com/2077-0383/10/19/4356infective endocarditismechanical prosthesisbiological prosthesismeta-analysislong-term outcome |
| spellingShingle | Francesco Formica Francesco Maestri Florida Gripshi Alan Gallingani Silvia Grossi Francesco Nicolini Long-Term Outcome of Mechanical and Biological Prostheses in Patients with Left-Side Infective Endocarditis: A Systematic Review and Meta-Analysis Journal of Clinical Medicine infective endocarditis mechanical prosthesis biological prosthesis meta-analysis long-term outcome |
| title | Long-Term Outcome of Mechanical and Biological Prostheses in Patients with Left-Side Infective Endocarditis: A Systematic Review and Meta-Analysis |
| title_full | Long-Term Outcome of Mechanical and Biological Prostheses in Patients with Left-Side Infective Endocarditis: A Systematic Review and Meta-Analysis |
| title_fullStr | Long-Term Outcome of Mechanical and Biological Prostheses in Patients with Left-Side Infective Endocarditis: A Systematic Review and Meta-Analysis |
| title_full_unstemmed | Long-Term Outcome of Mechanical and Biological Prostheses in Patients with Left-Side Infective Endocarditis: A Systematic Review and Meta-Analysis |
| title_short | Long-Term Outcome of Mechanical and Biological Prostheses in Patients with Left-Side Infective Endocarditis: A Systematic Review and Meta-Analysis |
| title_sort | long term outcome of mechanical and biological prostheses in patients with left side infective endocarditis a systematic review and meta analysis |
| topic | infective endocarditis mechanical prosthesis biological prosthesis meta-analysis long-term outcome |
| url | https://www.mdpi.com/2077-0383/10/19/4356 |
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