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- Title
Mitral valve prosthesis choice in patients <70 years: A systematic review and meta-analysis of 20 219 patients.
- Authors
Yanagawa, Bobby; Lee, Jessica; Ouzounian, Maral; Bagai, Akshay; Cheema, Asim; Verma, Subodh; Friedrich, Jan O.; on behalf of the Canadian Cardiovascular Surgery Meta‐Analysis Working Group; Canadian Cardiovascular Surgery Meta-Analysis Working Group; On Behalf Of The Canadian Cardiovascular Surgery Meta-Analysis Working Group
- Abstract
<bold>Background: </bold>The optimal mitral prosthesis in young patients is unclear. This systematic review and meta-analysis were performed to compare outcomes between bileaflet mechanical mitral valve replacement (mMVR) and bioprosthesis mitral valve replacement (bioMVR) for MVR patients aged less than 70 years.<bold>Methods: </bold>We searched MEDLINE and EMBASE databases from inception to July 2018 for studies comparing surgical outcomes of mMVR vs bioMVR.<bold>Results: </bold>There were 14 observational studies with 20 219 patients (n = 14 658 mMVR and n = 5561 bioMVR). Patients receiving an mMVR were younger with fewer comorbidities including renal failure, dialysis, and less-infective endocarditis (P < .001). The estimated 10-year mortality ranged from 19% to 49% for mMVR and 22% to 58% for bioMVR among studies. Comparing matched or adjusted data, mMVR was associated with lower operative (risk ratio [RR]: 0.61; 95% confidence interval [CI]: 0.39, 0.94; P = .03) and long-term (HR: 0.81; 95% CI: 0.71, 0.92; P = .002) mortality at a median follow-up of 8 years (IQR: 6-10 years). Estimated 10-year risk for mitral valve reoperation ranged from 0% to 8% for mMVR and 8% to 22% for bioMVR among matched/adjusted studies. mMVR was associated with lower matched/adjusted risk of reoperation (HR: 0.35; 95% CI: 0.19, 0.65; P = .001) but with greater risk of bleeding (HR: 1.59; 95% CI: 1.19, 2.13; P = .002) and a trend to greater risk of stroke and embolism (HR: 1.70; 95% CI: 0.92, 3.15; P = .09).<bold>Conclusion: </bold>Mechanical MVR in patients aged less than 70 years is associated with a lower risk of operative mortality as well as a 20% lower risk of long-term death and 65% lower risk of mitral valve reoperation but 60% greater risk of bleeding compared with bioMVR in matched or adjusted data.
- Subjects
MITRAL valve; META-analysis; PROSTHETICS; KIDNEY failure; COMORBIDITY; PERCUTANEOUS balloon valvuloplasty; MITRAL valve surgery; RELATIVE medical risk; RESEARCH; TIME; AGE distribution; RESEARCH methodology; SYSTEMATIC reviews; ENDOCARDITIS; EVALUATION research; MEDICAL cooperation; TREATMENT effectiveness; COMPARATIVE studies; PROSTHETIC heart valves; REOPERATION
- Publication
Journal of Cardiac Surgery, 2020, Vol 35, Issue 4, p818
- ISSN
0886-0440
- Publication type
journal article
- DOI
10.1111/jocs.14478