title: EFFICACY OF CARPENTIER-EDWARDS PERICARDIAL PROSTHESES: A SYSTEMATIC REVIEW AND META-ANALYSIS.
abstract: OBJECTIVE
  The Carpentier-Edwards pericardial (CEP) prostheses are the type of bioprostheses most used worldwide. Although they were designed to minimize the rate of valve deterioration and reoperation, their clinical superiority over other prostheses models still lacks confirmation. The objective of this study was to evaluate its effectiveness.
  
  
  METHODS
  We performed a systematic review and meta-analysis in the PubMed, Embase, Cochrane, and Lilacs databases. Operative mortality, overall mortality and reoperation rates after heart valve surgery were compared between the use of CEP and other cardiac prostheses. Two independent reviewers screened studies for inclusion and extracted the data. Disagreements were resolved by consensus. The GRADE criterion was used to assess the evidence quality.
  
  
  RESULTS
  A total of twenty-eight studies were selected, including 19,615 individuals. The studies presented a high heterogeneity and low quality of evidence what limited the reliability of the results. The pooled data from the selected studies did not demonstrate significant differences between CEP and porcine, pericardial or stentless prostheses regarding operative mortality, overall mortality and reoperation rates. However, the pooled data from 3 observational trials pointed out a higher risk for reoperation after valve replacement using CEP prostheses against mechanical prostheses (OR 4.92 [95 percent confidence interval 2.43-9.96]).
  
  
  CONCLUSIONS
  The current data present in the literature still does not support a clinical advantage for the use of CEP prostheses over other bioprostheses. The quality of the studies in the literature is limited and further studies are needed to address if CEP prostheses will have a clinical advantage over other prostheses.
authors.affiliation: Instituto Nacional de Cardiologiacarlosincnats@gmail.com.
authors.forename: Carlos Alberto S
authors.initials: CA
authors.lastname: Magliano
authors.affiliation: Instituto Nacional de Infectologia Evandro Chagas,Fundação Oswaldo Cruz.
authors.forename: Roberto M
authors.initials: RM
authors.lastname: Saraiva
authors.affiliation: Instituto Nacional de Cardiologia.
authors.forename: Vitor Manuel P
authors.initials: VM
authors.lastname: Azevedo
authors.affiliation: Instituto Nacional de Cardiologia.
authors.forename: Adriana M
authors.initials: AM
authors.lastname: Innocenzi
authors.affiliation: Instituto Nacional de Cardiologia.
authors.forename: Bernardo R
authors.initials: BR
authors.lastname: Tura
authors.affiliation: Instituto Nacional de Cardiologia.
authors.forename: Marisa
authors.initials: M
authors.lastname: Santos
mesh_terms: D000818:Animals; D001705:Bioprosthesis; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D011183:Postoperative Complications / Q000453:epidemiology; D012086:Reoperation / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D013552:Swine
keywords: Bioprostheses; Carpentier-Edwards prostheses; Meta-analysis; Systematic review