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

Francesco Formica; Francesco Maestri; Florida Gripshi; Alan Gallingani; Silvia Grossi; Francesco Nicolini

doi:10.3390/jcm10194356

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

J Clin Med. 2021 Sep 24;10(19):4356. doi: 10.3390/jcm10194356.

Authors

Francesco Formica^{1

2}, Francesco Maestri², Florida Gripshi², Alan Gallingani², Silvia Grossi³, Francesco Nicolini^{1

2}

Affiliations

¹ Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy.
² Cardiac Surgery Unit, University Hospital of Parma, 43126 Parma, Italy.
³ Department of Anesthesia and Intensive Care, Parma University Hospital, 43126 Parma, Italy.

Abstract

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; p < 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; p = 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; p < 0.0001). Meta-regression reported no effect of male gender (p = 0.09) and age (p = 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.

Keywords: biological prosthesis; infective endocarditis; long-term outcome; mechanical prosthesis; meta-analysis.

Publication types

Review