Long-Term Outcomes of Mechanical Versus Bioprosthetic Aortic Valve Replacement: A Systematic Review and Meta-Analysis.

Abstract

This study aimed to investigate the safety and efficacy of bioprosthetic (BV) versus mechanical valves (MV) on long-term outcomes in 50- to 70-year-old aortic stenosis (AS) patients. A literature search for articles published until April 2023 yielded 13 eligible studies, with 15,320 patients divided into BV (n = 7,320) and MV (n = 8,000) cohorts. The review was registered prospectively with PROSPERO (CRD42021278777). MV demonstrated a favorable hazard ratio (HR: 1.12, 95% CI: 1.00-1.25, I2= 60%) and higher survival rates at 5 (OR:1.13, 95% CI: 1.02-1.25, I2= 42%) and 10 years (OR: 1.13, 95% CI: 1.05-1.23, I2= 0%). At 15 years, stroke incidence was comparable (OR: 1.12, 95% CI: 0.98-1.27, I2= 4%). BV showed lower bleeding events (OR: 1.7, 95% CI: 1.18-2.46, I2= 88%), but MV replacement showed lower reoperation incidence (OR: 0.27, 95% CI: 0.18-0.42, I2= 85%). MV appears favorable for the long-term approach in AS management compared to BV.