Comparison of bioprosthesis and mechanical valves, a meta-analysis of randomised clinical trials.
The main purpose of this meta-analysis was to compare the outcomes of patients who randomly received mechanical valves or bioprosthesis, over a long-term clinical follow-up. We found only three trials meeting our selection criteria with a total of 1229 patients (8069. 5 patient-yr). Bleeding was more frequent in patients with mechanical prostheses both after 5 yr (RR=2.6; IC=[1.9;3.5]; P<0.0001) and 11 yr (RR=1.6; IC=[1.2;2.2]; P<0.001) of follow-up. However, the increased risk of bleeding at 11 yr was only statistically significant with mechanical prostheses in the aortic position (RR=1.93; IC=[1.36;2. 74]; P=0.0002). Reoperation was significantly more frequent in patients with bioprosthesis after 11 yr follow-up (RR=0.4; IC=[0.3;0. 6]; P<0.001). Endocarditis was more frequent after 11 yr (RR=0.6; IC=[0.3;0.95]; P<0.05) in patients with mechanical prostheses but these results were heterogeneous between mitral and aortic valves. The choice of valve type does not significantly influence survival.
Kassaï
B
B
Clinical Pharmacology Unit EA643, Cardiovascular Hospital, Rue Guillaume Paradin, BP 8071-69376, Cedex 08, Lyon, France. bk@upcl.univ-lyon1.fr
Gueyffier
F
F
Cucherat
M
M
Boissel
J P
JP
D001705:Bioprosthesis / Q000009:adverse effects; D004696:Endocarditis / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis / Q000009:adverse effects; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D016032:Randomized Controlled Trials as Topic; D012086:Reoperation; D012307:Risk Factors; D016896:Treatment Outcome