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HOMOGRAFT VERSUS CONVENTIONAL PROSTHESIS FOR SURGICAL MANAGEMENT OF AORTIC VALVE INFECTIVE ENDOCARDITIS A SYSTEMATIC REVIEW AND META-ANALYSIS
- Source :
- Canadian Journal of Cardiology. 33:S31-S32
- Publication Year :
- 2017
- Publisher :
- Elsevier BV, 2017.
-
Abstract
- Objective Surgical management of aortic valve infective endocarditis (IE) with cryopreserved homograft has been associated with lower risk of recurrent IE, but there is equipoise with regard to the optimal prosthesis. This systematic review and meta-analysis were performed to compare outcomes between homograft and conventional prosthesis for aortic valve IE. Methods We searched MEDLINE database to September 2017 for studies comparing homograft versus conventional prosthesis. The main outcomes were all-cause mortality, recurrent IE, and reoperation. Results There were 18 included comparative observational studies with 2232 patients (median follow up = 5 [interquartile range: 2–7] years, 30% prosthetic valve endocarditis); four studies were adjusted for baseline differences. There were no differences in perioperative mortality or stroke despite a greater proportion of staphylococcal endocarditis, abscess, and root replacements but less multivalve involvement in the homograft group. Long-term outcomes of all-cause mortality [incidence rate ratio (IRR) = 1.03, 95% confidence interval (CI) = 0.81–1.31, P = 0.83, for unmatched, and IRR = 0.82, 95% CI = 0.36–1.84, P = 0.63, for matched studies], recurrent endocarditis (IRR = 1.01, 95% CI = 0.53–1.93, P = 0.96, for unmatched, and IRR = 1.04, 95% CI = 0.49–2.19, P = 0.92, for matched studies), and reoperation (IRR = 1.60, 95% CI = 0.80–3.21, P = 0.18, for unmatched, and IRR = 3.17, 95% CI = 0.52–19.44, P = 0.21, for matched studies) were not different comparing homograft versus conventional prosthesis. There was a significantly increased need for reoperation with homograft versus mechanical prosthetic valves, but this comparison was based on limited data. Conclusions Homografts and conventional prostheses offer similar survival and freedom from recurrent endocarditis and reoperation for aortic valve IE. Homografts may be associated with greater risk of reoperation compared with mechanical valves.
- Subjects :
- Pulmonary and Respiratory Medicine
Aortic valve
medicine.medical_specialty
medicine.medical_treatment
Heart Valve Diseases
030204 cardiovascular system & hematology
Lower risk
Prosthesis
03 medical and health sciences
0302 clinical medicine
Postoperative Complications
Internal medicine
medicine
Endocarditis
Humans
Transplantation, Homologous
Retrospective Studies
Bioprosthesis
Heart Valve Prosthesis Implantation
business.industry
Retrospective cohort study
Endocarditis, Bacterial
General Medicine
Allografts
medicine.disease
Surgery
Transplantation
body regions
Treatment Outcome
surgical procedures, operative
medicine.anatomical_structure
030228 respiratory system
Aortic Valve
Heart Valve Prosthesis
Infective endocarditis
Meta-analysis
Cardiology
Cardiology and Cardiovascular Medicine
business
Subjects
Details
- ISSN :
- 0828282X
- Volume :
- 33
- Database :
- OpenAIRE
- Journal :
- Canadian Journal of Cardiology
- Accession number :
- edsair.doi.dedup.....db2ce5be049ce75bc9df0cf3d8a7a753