Aortic valve replacement for active infective endocarditis: 5-year survival comparison of bioprostheses, homografts and mechanical prostheses

Objective: In the surgical treatment of acute aortic valve infective endocarditis (IE), the long-term outcome depending on the choice of valve replacement remains uncertain. We aimed to compare the impact on 5-year mortality of use of three types of implanted valves: bioprosthesis (heterograft), mechanical prosthesis and homograft. Methods: A total of 167 patients with a definite aortic valve IE who underwent aortic replacement were selected from a prospective observational population-based study. Association between the type of implanted valve and 5-year mortality was examined by the use of an adjusted Cox model. Results: Bioprostheses were implanted in 31 patients (18.6%), homograft in 27 (16.2%) and mechanical valves in 109 (65.2%). Patients with bioprothesis had a higher 5-year mortality risk than patients with mechanical prosthesis (adjusted hazard ratio (HR) 2.39, 95% confidence interval (95% CI), 1.09–5.21; p = 0.029), particularly in patients ≤65 years old (adjusted HR 4.14 (1.27–13.45), p = 0.018) but not in patients >65 years old (adjusted HR: 1.45 (0.35–5.97), p = 0.60). Five-year mortality risk did not differ between patients with homografts and those with mechanical prostheses (HR 0.46, 95% CI (0.15–1.42), p = 0.18). Conclusions: A bioprosthetic valve used for aortic valve IE replacement may be associated with lower overall 5-year survival than the use of a mechanical valve in patients up to 65 years old. Further studies are needed to explain these results.