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Review
. 2023 Feb 20;10(2):90.
doi: 10.3390/jcdd10020090.

Mechanical versus Bioprosthetic Aortic Valve Replacement in Middle-Aged Adults: A Systematic Review and Meta-Analysis

Yefan Jiang  1 , Song Wang  1 , Jinhui Bian  1 , Si Chen  2 , Yongfeng Shao  1
Affiliations
Review

Mechanical versus Bioprosthetic Aortic Valve Replacement in Middle-Aged Adults: A Systematic Review and Meta-Analysis

Yefan Jiang et al. J Cardiovasc Dev Dis. .

Abstract

Background: Mechanical prostheses and bioprosthetic prostheses have their own advantages and disadvantages. Mechanical ones are recommended for younger patients (<50 years old), and bioprosthetic ones are recommended for older patients (>70 years old). There is still debate regarding which kind of prosthesis is better for middle-aged patients (50 to 70 years old) receiving aortic valve replacement (AVR). To solve this problem, we conducted this meta-analysis. Given that only one randomized controlled trial (RCT) study was included, we conducted a subgroup analysis of RCT and propensity score matching (PSM) retrospective studies to reduce the bias.

Methods: We systematically searched articles related to clinical outcomes of mechanical and bioprosthetic prostheses in middle-aged patients receiving AVR in the PubMed, Cochrane Library, and China National Knowledge Infrastructure (CNKI) databases. The published date was up to 1 October 2022. Studies were excluded if not only middle-aged patients were included, or if they lacked direct comparisons between mechanical and bioprosthetic prostheses.

Results: In total, 22 studies with 32,298 patients were included in the final analysis. The results show that patients aged between 50 and 70 receiving AVR with mechanical prostheses achieved better long-term survival and fewer reoperations and valve-related events but suffered more with bleeding events. No significant difference could be found in terms of early mortality and long-term cardiac death. The same results could be observed in the subgroup analysis of RCT and PSM retrospective studies.

Conclusion: Both mechanical and bioprosthetic prostheses are beneficial to middle-aged patients undertaking AVR procedures. However, mechanical prostheses show better clinical outcomes in long-term survival and comorbidities. Individual recommendation is still necessary.

Keywords: bioprosthetic prostheses; clinical outcomes; mechanical prostheses; meta-analysis; middle-aged.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The flowchart outlining the literature search process.
Figure 2
Figure 2
Meta-analysis for early mortality. (A) Bioprosthetic vs. mechanical. (B) Bioprosthetic vs. mechanical (RCT or PSM).
Figure 3
Figure 3
Meta-analysis for long-term survival. (A) Bioprosthetic vs. mechanical. (B) Bioprosthetic vs. mechanical (RCT or PSM).
Figure 4
Figure 4
Meta-analysis for freedom from cardiac death: bioprosthetic vs. mechanical.
Figure 5
Figure 5
Meta-analysis for freedom from reoperation. (A) Bioprosthetic vs. mechanical. (B) Bioprosthetic vs. mechanical (RCT or PSM).
Figure 6
Figure 6
Meta-analysis for freedom from valve-related events. (A) Bioprosthetic vs. mechanical. (B) Bioprosthetic vs. mechanical (RCT or PSM).
Figure 7
Figure 7
Meta-analysis for freedom from bleeding. (A) Bioprosthetic vs. mechanical. (B) Bioprosthetic vs. mechanical (RCT or PSM).
Figure 8
Figure 8
Meta-analysis for freedom from stroke. (A) Bioprosthetic vs. mechanical. (B) Bioprosthetic vs. mechanical (RCT or PSM).
See this image and copyright information in PMC

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