A Meta-analysis Of Biological Valves Versus Mechanical Valves In The Treatment Of Infective Endocarditis

Objective:The prognosis of infective endocarditis was evaluated by systematic evaluation of biological valve and mechanical valve,which provided guidance for clinical treatment.Methods:Pubmed,Embase,CNKI,WANFAN and Cochrane databases were searched from January 1960 to November 2016.Clinical studies comparing outcomes between biological valve and mechanical valve management for infective endocarditis were analyzed.The Newcastle-Ottawa Scale(NOS)was used to evaluate the quality of the literature and extracted data,and Stata 12.0 software was used for the meta-analysis.Results:A total of 11 publications were included,10,754 cases were selected,involving 6776 cases of biological valves and 3,978 cases of mechanical valves.The all-cause mortality risk of the biological valve group was higher than that of the mechanical valve group(HR=1.22,95% CI 1.03 to 1.44,P=0.023),as was early mortality(RR=1.21,95% CI 1.02 to 1.43,P =0.033).The recurrence of IE(HR=1.75,95% CI 1.26 to 2.42,P =0.001),as well as the risk of reoperation(HR=1.79,95% CI 1.15 to 2.80,P =0.010)were more likely to occur in the biological valve group.The incidence of postoperative embolism was less in the biological valve group than in the mechanical valve group,but this difference was not statistically significant(RR=0.90,95% CI 0.76 to 1.07,P =0.245).For patients with prosthetic valve endocarditis(PVE),there was no significant difference in survival rates between the biological valve group and the mechanical valve group(HR=0.91,95% CI 0.68 to 1.21,P =0.520).Conclusion:Surgical treatment of patients with infective endocarditis,the choice of mechanical valves can provide a better prognosis than biological valves,including lower postoperative mortality,recurrence rate and reoperation rate.The reason for this result may be related to the difference in the characteristics of patients rather than valve dysfunction.