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Outcomes after bioprosthetic versus mechanical mitral valve replacement for infective endocarditis in the United
Katie J Hogan1,2,3, Christopher B Sylvester1,2, Matthew J Wall1
1Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex.
Objective:
In patients who underwent mitral valve replacement for infectious endocarditis, we evaluated the association of prosthesis choice with readmission rates and causes (the primary outcomes), as well as with in-hospital mortality, cost, and length of stay (the secondary outcomes).
Methods:
Patients with infectious endocarditis who underwent isolated mitral valve replacement from January 2016 to December 2018 were identified in the United States Nationwide Readmissions Database and stratified by valve type. Propensity score matching was used to compare adjusted outcomes.
Results:
A weighted total of 4206 patients with infectious endocarditis underwent bioprosthetic mitral valve replacement (n = 3132) and mechanical mitral valve replacement (n = 1074) during the study period. Patients in the bioprosthetic mitral valve replacement group were older than those in the mechanical mitral valve replacement group (median 57 vs 46 y, P < .001). After propensity matching, the bioprosthetic mitral valve replacement group (n = 1068) had similar in-hospital mortality, length of stay, and costs compared with the mechanical mitral valve replacement group (n = 1056). Overall, 90-day readmission rates were high (28.9%) and comparable for bioprosthetic mitral valve replacement (30.5%) and mechanical mitral valve replacement (27.5%, P = .4). Likewise, there was no difference in readmissions over a calendar year by prosthesis type. Readmissions for infection and bleeding were common for both bioprosthetic mitral valve replacement and mechanical mitral valve replacement groups.
Conclusions:
Outcomes and readmission rates were similar for mechanical mitral valve replacement and bioprosthetic mitral valve replacement in infectious endocarditis, suggesting that valve choice should not be determined by endocarditis status. Additionally, strategies to mitigate readmission for infection and bleeding are needed for both groups.
Insights
For infectious endocarditis patients, mitral valve replacement with either bioprosthetic or mechanical valves showed similar outcomes and readmission rates. Strategies are needed to reduce readmissions for infection and bleeding in both groups.
Area of Science:
- Cardiology
- Cardiac Surgery
- Infectious Diseases
Background:
- Infectious endocarditis often necessitates mitral valve replacement.
- The choice between bioprosthetic and mechanical mitral valves is a critical decision in surgical management.
Purpose of the Study:
- To evaluate the association of prosthesis choice (bioprosthetic vs. mechanical mitral valve replacement) with readmission rates and causes in patients with infectious endocarditis.
- To compare secondary outcomes including in-hospital mortality, cost, and length of stay between the two prosthesis types.
Main Methods:
- Retrospective analysis of patients who underwent isolated mitral valve replacement for infectious endocarditis from January 2016 to December 2018 using the US Nationwide Readmissions Database.
- Propensity score matching was employed to compare outcomes between bioprosthetic mitral valve replacement and mechanical mitral valve replacement groups.
Main Results:
- A total of 4206 patients were included; 3132 received bioprosthetic valves and 1074 received mechanical valves.
- After propensity matching, both groups exhibited similar in-hospital mortality, length of stay, and costs.
- Ninety-day readmission rates were high (28.9%) and comparable between bioprosthetic (30.5%) and mechanical (27.5%) mitral valve replacement groups, with infection and bleeding being common causes.
Conclusions:
- Mitral valve prosthesis choice (bioprosthetic vs. mechanical) did not significantly impact outcomes or readmission rates in patients with infectious endocarditis.
- Endocarditis status alone should not dictate mitral valve prosthesis selection.
- Further strategies are required to reduce readmissions related to infection and bleeding for both bioprosthetic and mechanical mitral valve replacement recipients.
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