title: Aortic valve replacement for active infective endocarditis: 5-year survival comparison of bioprostheses, homografts and mechanical prostheses.
abstract: 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 < or =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.
authors.affiliation: CHU de Nancy, 54000, France; Nancy-Université, Faculté de médecine, EA4003, Nancy, 54000, France.
authors.forename: Duc Trung
authors.initials: DT
authors.lastname: Nguyen
authors.forename: François
authors.initials: F
authors.lastname: Delahaye
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Obadia
authors.forename: Xavier
authors.initials: X
authors.lastname: Duval
authors.forename: Christine
authors.initials: C
authors.lastname: Selton-Suty
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Carteaux
authors.forename: Bruno
authors.initials: B
authors.lastname: Hoen
authors.forename: François
authors.initials: F
authors.lastname: Alla
mesh_terms: D000208:Acute Disease; D000328:Adult; D000367:Age Factors; D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D001705:Bioprosthesis; D002755:Choice Behavior; D004697:Endocarditis, Bacterial / Q000601:surgery*; D004812:Epidemiologic Methods; D005260:Female; D006349:Heart Valve Diseases / Q000382:microbiology / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011474:Prosthesis Design; D013318:Stroke Volume; D016896:Treatment Outcome