Mechanical vs. Bioprosthetic Heart Valves in Patients Younger Than 70 Years of Age – a Meta-Analysis of Randomised Trials and Propensity Score Matched Observational Studies

Introduction

The choice between mechanical valves (MV) and bioprosthetic valves (BV) in patients undergoing left sided valve surgery is a complex one, requiring a balance between the inferior durability of BV and the need for long term oral anticoagulation with MV. This is especially challenging in middle aged patients (

Metirials and Methods

We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies with propensity score matching (PSM) comparing BV vs. MV in patients

The primary outcome was overall mortality. Secondary outcomes included cardiovascular mortality, bleeding events, reoperation, systemic thromboembolism and cerebrovascular accident (CVA)

Results and Disscusion

Twelve studies (2 RCT and 10 PSM studies, aggregate sample size 8,577 patients) were included. Median follow up was 7.6 years. The primary endpoint was higher with BV vs. MV (35.7% vs. 31.6%, OR 1.24[1.14-1.38] p<0.01), as was cardiovascular mortality (13.2% vs. 7.6%, OR 1.96[1.66-2.32] p<0.01) and reoperation (9.9% vs. 5.2%, OR 2.47[2.04-2.99] p<0.01). Bleeding risk was lower with BV (7.6% vs. 13.2%, OR 0.51[0.43-0.60], p<0.01). CVA and systemic thromboembolism were similar between BV and MV.

Sensitivity analysis’ restricted to aortic valve replacement only and to patients aged 50-70 showed consistent results to the main analysis

Conclusions

In the largest meta-analysis of BV vs. MV, our results suggest a survival benefit for MV in patients