Long‐term outcome of mechanical and biological prostheses in patients with left‐side infective endocarditis: A systematic review and meta‐analysis

Background. 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. Methods. 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. Results. 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; p < 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; p = 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; p < 0.0001). Meta‐regression reported no effect of male gender (p = 0.09) and age (p = 0.77) on long‐term survival. Conclusions. 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.