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Mechanical versus biological valve prostheses for left-sided infective endocarditis

Amila Kahrovic1, Philipp Angleitner1, Harald Herkner2

  • 1Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|February 9, 2022
PubMed

Insights

For patients under 55 with left-sided infective endocarditis, mechanical valve replacement significantly reduces mortality and adverse events compared to biological valves. Further research is recommended to confirm these findings.

Area of Science:

  • Cardiac Surgery
  • Infective Endocarditis
  • Prosthetic Heart Valves

Background:

  • Left-sided infective endocarditis poses significant risks.
  • Valve replacement is a critical intervention for these patients.
  • The choice between mechanical and biological prostheses is debated.

Purpose of the Study:

  • To compare outcomes of mechanical versus biological valve prostheses in patients with left-sided infective endocarditis.
  • To identify patient subgroups that may benefit more from specific valve types.

Main Methods:

  • Retrospective single-centre cohort study of 220 adult patients (2009-2018).
  • Analysis of all-cause mortality, combined events (death, stroke, bleeding, reoperation), and re-endocarditis risk.
  • Statistical analysis adjusted for relevant risk factors.

Main Results:

  • Mechanical valve recipients were younger and had lower surgical risk scores.
  • In patients <55 years, mechanical valves were associated with significantly lower all-cause mortality (aHR 0.35) and combined events (aHR 0.38).
  • No increased re-endocarditis risk with mechanical valves; annular abscess increased re-endocarditis risk (aHR 3.06).

Conclusions:

  • Mechanical valve implantation is associated with superior outcomes in patients <55 years with left-sided infective endocarditis.
  • These findings suggest a potential benefit of mechanical valves in younger patients.
  • A prospective randomized controlled trial is recommended for confirmation.
Abstract

Keywords:
Biological valve prosthesisInfective endocarditisMechanical valve prosthesis

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