Long-Term Outcomes of Bioprosthetic Valves in the Mitral Position: A Pooled Meta-Analysis of Reconstructed Time-to-Event Individual Patient Data

Bioprosthetic mitral valve replacement (bMVR) use is increasing; however, data regarding long-term durability are lacking. We sought to perform a reconstructed individual patient data meta-analysis from published Kaplan–Meier curves to ascertain survival, freedom from valve degeneration, and reopera...

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Bibliographic Details
Published in:The American journal of cardiology 2024-06, Vol.221, p.64-73
Main Authors: Koulouroudias, Marinos, Di Mauro, Michele, Chiariello, Giovanni, Meani, Paolo, Lorusso, Roberto
Format: Article
Language:English
Subjects:
Age
Age factors
Age groups
Animals
Bioprosthesis
bioprosthetic valves
Cattle
Degeneration
Durability
Heart Valve Diseases - surgery
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation - methods
Humans
long-term outcomes
Meta-analysis
Mitral valve
Mitral Valve - surgery
mitral valve replacement
Mortality
Patients
Prostheses
Prosthesis Design
Prosthesis Failure
Reoperation - statistics & numerical data
structural valve deterioration
Survival
Systematic review
Thoracic surgery
Time Factors
Treatment Outcome
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Summary:Bioprosthetic mitral valve replacement (bMVR) use is increasing; however, data regarding long-term durability are lacking. We sought to perform a reconstructed individual patient data meta-analysis from published Kaplan–Meier curves to ascertain survival, freedom from valve degeneration, and reoperation in studies published since 2010. We explored the effects of age and valve type (bovine pericardial or porcine valve) on outcomes. We searched MEDLINE, OVID, Embase, and Cochrane CENTRAL for studies reporting at least 3 years of follow-up after bMVR and published since 2010. The Risk Of Bias In Non-randomised Studies of Interventions (ROBINS-I) tool was used to assess methodologic quality. Kaplan–Meier curves were digitized to extract individual patient data and reconstructed estimates for overall survival, freedom from structural valve deterioration (SVD), and freedom from reoperation. A total of 20 studies (16,465 patients) were included. A total of 9 studies reported on porcine valves, 6 reported on bovine, and 7 did not specify the valve type. The overall survival after bMVR at 15 years was 40% (confidence interval 38% to 42%), freedom from reoperation at 15 years was 79% (confidence interval 76% to 82%), and freedom from SVD at 15 years was 64% (58% to 70%). Freedom from SVD was improved in the 70+ years age group (93% up to 25 years, hazard ratio 6.6 [2.5 to 17] for 18 to 59 vs >70 years, p
ISSN:0002-9149
1879-1913
1879-1913
DOI:10.1016/j.amjcard.2024.04.008