Formica Francesco, Maestri Francesco, Gripshi Florida, Gallingani Alan, Grossi Silvia, Nicolini Francesco
Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy.
Cardiac Surgery Unit, University Hospital of Parma, 43126 Parma, Italy.
J Clin Med. 2021 Sep 24;10(19):4356. doi: 10.3390/jcm10194356.
Long-term outcomes of patients with infective endocarditis (IE) who received either a mechanical (MP) or biological prosthesis (BP) are conflicting. A meta-analysis of observational studies comparing the long-term outcomes of left-side IE with the use of MP versus BP was performed.
Electronic databases from January 2000 to June 2021 were screened. Studies reporting long-term mortality were analyzed. The primary endpoint was long-term overall mortality. Secondary endpoints were in-hospital/.30-day mortality and freedom from both prosthesis reinfection and reintervention. The pooled hazard ratio (HR) with 95% confidence interval (CI) was calculated for survival according to the random effect model.
Thirteen retrospective observational studies reporting on 8645 patients (MP: 4688; BP: 4137) were included for comparison. Twelve studies reported data of long-term survival for a total of 8285 patients (MP: 4517; BP: 3768). The pooled analysis revealed that the use of MP was statistically associated with longer benefits compared to BP (HR 0.74; 95% CI 0.63-0.86; < 0.0001). The median follow-up time ranged from 1 to 15.3 years. The pooled analysis of five studies reporting data on prosthesis reinfection in 4491 patients (MP: 2433; BP: 2058) did not reveal significant differences (HR 0.60; 95% CI 0.30-1.21; = 0.15). Five studies reported data on prosthesis reintervention in 4401 patients (MP: 2307; BP: 2094). The meta-analysis revealed a significant difference in favor of MP (HR 0.40; 95% CI 0.29-0.55; < 0.0001). Meta-regression reported no effect of male gender ( = 0.09) and age ( = 0.77) on long-term survival.
In a meta-analysis of retrospective observational studies comparing the long-term outcome of patients who underwent surgery for left-sided IE, the use of MP compared to BP is associated with a significant longer-term survival and with a reduced incidence of late reoperation. The incidence of late reinfection is comparable between the two prostheses.
感染性心内膜炎（IE）患者接受机械瓣膜（MP）或生物瓣膜（BP）置换后的长期预后存在争议。我们对比较左侧IE患者使用MP与BP的长期预后的观察性研究进行了荟萃分析。
筛选了2000年1月至2021年6月的电子数据库。分析报告长期死亡率的研究。主要终点是长期总体死亡率。次要终点是住院/30天死亡率以及无人工瓣膜再感染和再次干预。根据随机效应模型计算生存的合并风险比（HR）及其95%置信区间（CI）。
纳入13项回顾性观察性研究，共8645例患者（MP组：4688例；BP组：4137例）进行比较。12项研究报告了8285例患者（MP组：4517例；BP组：3768例）的长期生存数据。汇总分析显示，与BP相比，使用MP在统计学上具有更长的获益（HR 0.74；95% CI 0.63 - 0.86；P < 0.0001）。中位随访时间为1至15.3年。对4491例患者（MP组：2433例；BP组：2058例）的人工瓣膜再感染数据进行的5项研究的汇总分析未发现显著差异（HR 0.60；95% CI 0.30 - 1.21；P = 0.15）。5项研究报告了4401例患者（MP组：2307例；BP组：2094例）的人工瓣膜再次干预数据。荟萃分析显示有利于MP的显著差异（HR 0.40；95% CI 0.29 - 0.55；P < 0.0001）。荟萃回归报告男性性别（P = 0.09）和年龄（P = 0.77）对长期生存无影响。
在一项比较左侧IE手术患者长期预后的回顾性观察性研究的荟萃分析中，与BP相比，使用MP与显著更长的长期生存和更低的晚期再次手术发生率相关。两种瓣膜的晚期再感染发生率相当。
