Bioprosthetic versus mechanical valves for mitral valve replacement in patients < 70 years: an updated pairwise meta-analysis
Background The ideal conduit for mitral valve replacement (MVR) remains elusive, particularly among younger patients due to increased life expectancy. We perform a pairwise meta-analysis comparing the use of bioprosthetic valves (BPV) and mechanical mitral valves (MMV) in patients
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| Veröffentlicht in: | General thoracic and cardiovascular surgery 2024-02, Vol.72 (2), p.95-103 |
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| creator | Ahmed, Adham Awad, Ahmed K. Varghese, Kathryn S. Sehgal, Viren S. Hisham, Kenzy George, Jerrin Pandey, Roshan Vega, Eamon Polizzi, Mia Mathew, Dave M. |
| description | Background
The ideal conduit for mitral valve replacement (MVR) remains elusive, particularly among younger patients due to increased life expectancy. We perform a pairwise meta-analysis comparing the use of bioprosthetic valves (BPV) and mechanical mitral valves (MMV) in patients |
| doi_str_mv | 10.1007/s11748-023-01956-1 |
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| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2835273133</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2835273133</sourcerecordid><originalsourceid>FETCH-LOGICAL-c298t-d935d11bd5136ef0dec9f4c8271e580c6f9461b139dc8f82f363b2e585cd69193</originalsourceid><addsrcrecordid>eNp9kLtuFTEQhlcIRC7wAhTIJc0Gz3rttRENRFwiRUoDteVjzxJHe8PjPdHpEB1vkWfhUfIkGE6SkmI0I883v-Svql4APwHOu9cE0LW65o2oORipanhUHYJWolYdiMcPM5cH1RHRFedSaZBPqwPRtdCaDg6rn-_jvKSZ8iXm6NkWE63ERvSXboreDWzrhi0S6-fExpjT_QtLuAzO44hTZnFii8uxjHT749fbUh3_fbNDl-gNcxNbl-AyhgLFdB0JS352tZvcsKNIz6onvRsIn9_14-rrxw9fTj_X5xefzk7fnde-MTrXwQgZADZBglDY84De9K3XTQcoNfeqN62CDQgTvO510wslNk1ZSR-UASOOq1f73PLf7ytStmMkj8PgJpxXso0WsukECFHQZo_6ooYS9nZJcXRpZ4Hbv-7t3r0t7u0_9xbK0cu7_HUzYng4uZddALEHqKymb5js1bymYoH-F_sHuHmUPA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2835273133</pqid></control><display><type>article</type><title>Bioprosthetic versus mechanical valves for mitral valve replacement in patients < 70 years: an updated pairwise meta-analysis</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><creator>Ahmed, Adham ; Awad, Ahmed K. ; Varghese, Kathryn S. ; Sehgal, Viren S. ; Hisham, Kenzy ; George, Jerrin ; Pandey, Roshan ; Vega, Eamon ; Polizzi, Mia ; Mathew, Dave M.</creator><creatorcontrib>Ahmed, Adham ; Awad, Ahmed K. ; Varghese, Kathryn S. ; Sehgal, Viren S. ; Hisham, Kenzy ; George, Jerrin ; Pandey, Roshan ; Vega, Eamon ; Polizzi, Mia ; Mathew, Dave M.</creatorcontrib><description>Background
The ideal conduit for mitral valve replacement (MVR) remains elusive, particularly among younger patients due to increased life expectancy. We perform a pairwise meta-analysis comparing the use of bioprosthetic valves (BPV) and mechanical mitral valves (MMV) in patients < 70 years old undergoing MVR.
Methods
We comprehensively searched medical databases to identify studies comparing the use of BPV and MMV in patients < 70 years old undergoing MVR. Pairwise meta-analysis was performed using the Mantel–Haenszel method in R version 4.0.2. Outcomes were pooled using the random effect model as risk ratios (RR) with their 95% confidence intervals (95% CI).
Results
16,879 patients from 15 studies were pooled. Compared to MMV, BPV was associated with significantly higher rates of 30-day mortality (RR 1.53,
p
= 0.0006) but no difference in 30-day stroke (RR 0.70,
p
= 0.43). At a weighted mean follow-up duration of 14.1 years, BPV was associated with higher rates of long-term mortality (RR 1.28,
p
= 0.0054). No difference was seen between the two groups for risk of long-term stroke (RR 0.92,
p
= 0.67), reoperation(RR 1.72,
p
= 0.12), or major-bleeding (RR 0.57,
p
= 0.10) at a weighted mean follow-up duration of 11.7, 11.3, and 11.9 years, respectively.
Conclusion
The use of MMV in patients < 70 undergoing MVR is associated with lower rates of 30-day/long-term mortality compared to BPV. No significant differences were observed for risk of 30-day/long-term stroke, long-term reoperation, and long-term major bleeding. These findings support the use of MMV in younger patients, although prospective, randomized trials are still needed.</description><identifier>ISSN: 1863-6705</identifier><identifier>EISSN: 1863-6713</identifier><identifier>DOI: 10.1007/s11748-023-01956-1</identifier><identifier>PMID: 37414971</identifier><language>eng</language><publisher>Singapore: Springer Nature Singapore</publisher><subject>Aged ; Aortic Valve - surgery ; Bioprosthesis - adverse effects ; Cardiac Surgery ; Cardiology ; Heart Valve Prosthesis - adverse effects ; Heart Valve Prosthesis Implantation - methods ; Hemorrhage - etiology ; Humans ; Medicine ; Medicine & Public Health ; Mitral Valve - surgery ; Original Article ; Prospective Studies ; Reoperation ; Stroke - etiology ; Surgical Oncology ; Thoracic Surgery ; Treatment Outcome</subject><ispartof>General thoracic and cardiovascular surgery, 2024-02, Vol.72 (2), p.95-103</ispartof><rights>The Author(s), under exclusive licence to The Japanese Association for Thoracic Surgery 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2023. The Author(s), under exclusive licence to The Japanese Association for Thoracic Surgery.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c298t-d935d11bd5136ef0dec9f4c8271e580c6f9461b139dc8f82f363b2e585cd69193</cites><orcidid>0000-0002-8998-8267</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s11748-023-01956-1$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s11748-023-01956-1$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,778,782,27911,27912,41475,42544,51306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37414971$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ahmed, Adham</creatorcontrib><creatorcontrib>Awad, Ahmed K.</creatorcontrib><creatorcontrib>Varghese, Kathryn S.</creatorcontrib><creatorcontrib>Sehgal, Viren S.</creatorcontrib><creatorcontrib>Hisham, Kenzy</creatorcontrib><creatorcontrib>George, Jerrin</creatorcontrib><creatorcontrib>Pandey, Roshan</creatorcontrib><creatorcontrib>Vega, Eamon</creatorcontrib><creatorcontrib>Polizzi, Mia</creatorcontrib><creatorcontrib>Mathew, Dave M.</creatorcontrib><title>Bioprosthetic versus mechanical valves for mitral valve replacement in patients < 70 years: an updated pairwise meta-analysis</title><title>General thoracic and cardiovascular surgery</title><addtitle>Gen Thorac Cardiovasc Surg</addtitle><addtitle>Gen Thorac Cardiovasc Surg</addtitle><description>Background
The ideal conduit for mitral valve replacement (MVR) remains elusive, particularly among younger patients due to increased life expectancy. We perform a pairwise meta-analysis comparing the use of bioprosthetic valves (BPV) and mechanical mitral valves (MMV) in patients < 70 years old undergoing MVR.
Methods
We comprehensively searched medical databases to identify studies comparing the use of BPV and MMV in patients < 70 years old undergoing MVR. Pairwise meta-analysis was performed using the Mantel–Haenszel method in R version 4.0.2. Outcomes were pooled using the random effect model as risk ratios (RR) with their 95% confidence intervals (95% CI).
Results
16,879 patients from 15 studies were pooled. Compared to MMV, BPV was associated with significantly higher rates of 30-day mortality (RR 1.53,
p
= 0.0006) but no difference in 30-day stroke (RR 0.70,
p
= 0.43). At a weighted mean follow-up duration of 14.1 years, BPV was associated with higher rates of long-term mortality (RR 1.28,
p
= 0.0054). No difference was seen between the two groups for risk of long-term stroke (RR 0.92,
p
= 0.67), reoperation(RR 1.72,
p
= 0.12), or major-bleeding (RR 0.57,
p
= 0.10) at a weighted mean follow-up duration of 11.7, 11.3, and 11.9 years, respectively.
Conclusion
The use of MMV in patients < 70 undergoing MVR is associated with lower rates of 30-day/long-term mortality compared to BPV. No significant differences were observed for risk of 30-day/long-term stroke, long-term reoperation, and long-term major bleeding. These findings support the use of MMV in younger patients, although prospective, randomized trials are still needed.</description><subject>Aged</subject><subject>Aortic Valve - surgery</subject><subject>Bioprosthesis - adverse effects</subject><subject>Cardiac Surgery</subject><subject>Cardiology</subject><subject>Heart Valve Prosthesis - adverse effects</subject><subject>Heart Valve Prosthesis Implantation - methods</subject><subject>Hemorrhage - etiology</subject><subject>Humans</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Mitral Valve - surgery</subject><subject>Original Article</subject><subject>Prospective Studies</subject><subject>Reoperation</subject><subject>Stroke - etiology</subject><subject>Surgical Oncology</subject><subject>Thoracic Surgery</subject><subject>Treatment Outcome</subject><issn>1863-6705</issn><issn>1863-6713</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kLtuFTEQhlcIRC7wAhTIJc0Gz3rttRENRFwiRUoDteVjzxJHe8PjPdHpEB1vkWfhUfIkGE6SkmI0I883v-Svql4APwHOu9cE0LW65o2oORipanhUHYJWolYdiMcPM5cH1RHRFedSaZBPqwPRtdCaDg6rn-_jvKSZ8iXm6NkWE63ERvSXboreDWzrhi0S6-fExpjT_QtLuAzO44hTZnFii8uxjHT749fbUh3_fbNDl-gNcxNbl-AyhgLFdB0JS352tZvcsKNIz6onvRsIn9_14-rrxw9fTj_X5xefzk7fnde-MTrXwQgZADZBglDY84De9K3XTQcoNfeqN62CDQgTvO510wslNk1ZSR-UASOOq1f73PLf7ytStmMkj8PgJpxXso0WsukECFHQZo_6ooYS9nZJcXRpZ4Hbv-7t3r0t7u0_9xbK0cu7_HUzYng4uZddALEHqKymb5js1bymYoH-F_sHuHmUPA</recordid><startdate>20240201</startdate><enddate>20240201</enddate><creator>Ahmed, Adham</creator><creator>Awad, Ahmed K.</creator><creator>Varghese, Kathryn S.</creator><creator>Sehgal, Viren S.</creator><creator>Hisham, Kenzy</creator><creator>George, Jerrin</creator><creator>Pandey, Roshan</creator><creator>Vega, Eamon</creator><creator>Polizzi, Mia</creator><creator>Mathew, Dave M.</creator><general>Springer Nature Singapore</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-8998-8267</orcidid></search><sort><creationdate>20240201</creationdate><title>Bioprosthetic versus mechanical valves for mitral valve replacement in patients < 70 years: an updated pairwise meta-analysis</title><author>Ahmed, Adham ; Awad, Ahmed K. ; Varghese, Kathryn S. ; Sehgal, Viren S. ; Hisham, Kenzy ; George, Jerrin ; Pandey, Roshan ; Vega, Eamon ; Polizzi, Mia ; Mathew, Dave M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c298t-d935d11bd5136ef0dec9f4c8271e580c6f9461b139dc8f82f363b2e585cd69193</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Aged</topic><topic>Aortic Valve - surgery</topic><topic>Bioprosthesis - adverse effects</topic><topic>Cardiac Surgery</topic><topic>Cardiology</topic><topic>Heart Valve Prosthesis - adverse effects</topic><topic>Heart Valve Prosthesis Implantation - methods</topic><topic>Hemorrhage - etiology</topic><topic>Humans</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Mitral Valve - surgery</topic><topic>Original Article</topic><topic>Prospective Studies</topic><topic>Reoperation</topic><topic>Stroke - etiology</topic><topic>Surgical Oncology</topic><topic>Thoracic Surgery</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ahmed, Adham</creatorcontrib><creatorcontrib>Awad, Ahmed K.</creatorcontrib><creatorcontrib>Varghese, Kathryn S.</creatorcontrib><creatorcontrib>Sehgal, Viren S.</creatorcontrib><creatorcontrib>Hisham, Kenzy</creatorcontrib><creatorcontrib>George, Jerrin</creatorcontrib><creatorcontrib>Pandey, Roshan</creatorcontrib><creatorcontrib>Vega, Eamon</creatorcontrib><creatorcontrib>Polizzi, Mia</creatorcontrib><creatorcontrib>Mathew, Dave M.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>General thoracic and cardiovascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ahmed, Adham</au><au>Awad, Ahmed K.</au><au>Varghese, Kathryn S.</au><au>Sehgal, Viren S.</au><au>Hisham, Kenzy</au><au>George, Jerrin</au><au>Pandey, Roshan</au><au>Vega, Eamon</au><au>Polizzi, Mia</au><au>Mathew, Dave M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Bioprosthetic versus mechanical valves for mitral valve replacement in patients < 70 years: an updated pairwise meta-analysis</atitle><jtitle>General thoracic and cardiovascular surgery</jtitle><stitle>Gen Thorac Cardiovasc Surg</stitle><addtitle>Gen Thorac Cardiovasc Surg</addtitle><date>2024-02-01</date><risdate>2024</risdate><volume>72</volume><issue>2</issue><spage>95</spage><epage>103</epage><pages>95-103</pages><issn>1863-6705</issn><eissn>1863-6713</eissn><abstract>Background
The ideal conduit for mitral valve replacement (MVR) remains elusive, particularly among younger patients due to increased life expectancy. We perform a pairwise meta-analysis comparing the use of bioprosthetic valves (BPV) and mechanical mitral valves (MMV) in patients < 70 years old undergoing MVR.
Methods
We comprehensively searched medical databases to identify studies comparing the use of BPV and MMV in patients < 70 years old undergoing MVR. Pairwise meta-analysis was performed using the Mantel–Haenszel method in R version 4.0.2. Outcomes were pooled using the random effect model as risk ratios (RR) with their 95% confidence intervals (95% CI).
Results
16,879 patients from 15 studies were pooled. Compared to MMV, BPV was associated with significantly higher rates of 30-day mortality (RR 1.53,
p
= 0.0006) but no difference in 30-day stroke (RR 0.70,
p
= 0.43). At a weighted mean follow-up duration of 14.1 years, BPV was associated with higher rates of long-term mortality (RR 1.28,
p
= 0.0054). No difference was seen between the two groups for risk of long-term stroke (RR 0.92,
p
= 0.67), reoperation(RR 1.72,
p
= 0.12), or major-bleeding (RR 0.57,
p
= 0.10) at a weighted mean follow-up duration of 11.7, 11.3, and 11.9 years, respectively.
Conclusion
The use of MMV in patients < 70 undergoing MVR is associated with lower rates of 30-day/long-term mortality compared to BPV. No significant differences were observed for risk of 30-day/long-term stroke, long-term reoperation, and long-term major bleeding. These findings support the use of MMV in younger patients, although prospective, randomized trials are still needed.</abstract><cop>Singapore</cop><pub>Springer Nature Singapore</pub><pmid>37414971</pmid><doi>10.1007/s11748-023-01956-1</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-8998-8267</orcidid></addata></record> |
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| source | MEDLINE; Springer Nature - Complete Springer Journals |
| subjects | Aged Aortic Valve - surgery Bioprosthesis - adverse effects Cardiac Surgery Cardiology Heart Valve Prosthesis - adverse effects Heart Valve Prosthesis Implantation - methods Hemorrhage - etiology Humans Medicine Medicine & Public Health Mitral Valve - surgery Original Article Prospective Studies Reoperation Stroke - etiology Surgical Oncology Thoracic Surgery Treatment Outcome |
| title | Bioprosthetic versus mechanical valves for mitral valve replacement in patients < 70 years: an updated pairwise meta-analysis |
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