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Bioprosthetic versus mechanical valves for mitral valve replacement in patients < 70 years: an updated pairwise meta-analysis

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Abstract

Background

The ideal conduit for mitral valve replacement (MVR) remains elusive, particularly among younger patients due to increased life expectancy. We perform a pairwise meta-analysis comparing the use of bioprosthetic valves (BPV) and mechanical mitral valves (MMV) in patients < 70 years old undergoing MVR.

Methods

We comprehensively searched medical databases to identify studies comparing the use of BPV and MMV in patients < 70 years old undergoing MVR. Pairwise meta-analysis was performed using the Mantel–Haenszel method in R version 4.0.2. Outcomes were pooled using the random effect model as risk ratios (RR) with their 95% confidence intervals (95% CI).

Results

16,879 patients from 15 studies were pooled. Compared to MMV, BPV was associated with significantly higher rates of 30-day mortality (RR 1.53, p = 0.0006) but no difference in 30-day stroke (RR 0.70, p = 0.43). At a weighted mean follow-up duration of 14.1 years, BPV was associated with higher rates of long-term mortality (RR 1.28, p = 0.0054). No difference was seen between the two groups for risk of long-term stroke (RR 0.92, p = 0.67), reoperation(RR 1.72, p = 0.12), or major-bleeding (RR 0.57, p = 0.10) at a weighted mean follow-up duration of 11.7, 11.3, and 11.9 years, respectively.

Conclusion

The use of MMV in patients < 70 undergoing MVR is associated with lower rates of 30-day/long-term mortality compared to BPV. No significant differences were observed for risk of 30-day/long-term stroke, long-term reoperation, and long-term major bleeding. These findings support the use of MMV in younger patients, although prospective, randomized trials are still needed.

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Authors and Affiliations

  1. CUNY School of Medicine, 1589 Amsterdam Avenue, New York, NY, 10031, USA

    Adham Ahmed, Kathryn S. Varghese, Viren S. Sehgal, Roshan Pandey, Eamon Vega, Mia Polizzi & Dave M. Mathew

  2. Faculty of Medicine, Ain Shams University, Cairo, Egypt

    Ahmed K. Awad & Kenzy Hisham

  3. University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA

    Jerrin George

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  1. Adham Ahmed
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Ahmed, A., Awad, A.K., Varghese, K.S. et al. Bioprosthetic versus mechanical valves for mitral valve replacement in patients < 70 years: an updated pairwise meta-analysis. Gen Thorac Cardiovasc Surg 72, 95–103 (2024). https://doi.org/10.1007/s11748-023-01956-1

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