Patient Risk Factors for Bioprosthetic Aortic Valve Degeneration: A Systematic Review and Meta-Analysis

The choice of valve type for aortic valve replacement surgery is sometimes challenging. The main risk for bioprostheses is structural valve degeneration (SVD); however, little is known about what the most important risk factors are. We conducted a systematic review and meta-analysis to identify the...

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Bibliographic Details
Published in:Heart, lung & circulation lung & circulation, 2020-05, Vol.29 (5), p.668-678
Main Authors: Ochi, Ayame, Cheng, Kevin, Zhao, Bing, Hardikar, Ashutosh A., Negishi, Kazuaki
Format: Article
Language:English
Subjects:
Aortic valve
Aortic Valve - surgery
Bioprosthesis - adverse effects
Heart Valve Diseases - surgery
Heart Valve Prosthesis - adverse effects
Heart Valve Prosthesis Implantation - adverse effects
Humans
Meta-analysis
Postoperative Complications
Prosthesis Design
Prosthesis Failure
Risk Factors
Structural valve degeneration
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Summary:The choice of valve type for aortic valve replacement surgery is sometimes challenging. The main risk for bioprostheses is structural valve degeneration (SVD); however, little is known about what the most important risk factors are. We conducted a systematic review and meta-analysis to identify the risk factors and estimate their pooled effect sizes to aid the prosthesis choice for replacement. We followed PRISMA guidelines and systematically searched three electronic databases (PubMed, Scopus, and Web of Science) using appropriate key terms: ‘aortic valve’, ‘bioprosthesis’, ‘degeneration’, ‘durability’, ‘prosthesis failure’, etc. Hazard ratio (HR) and odds ratio (OR) and associated 95% confidence intervals (CI) were extracted. Pooled risk estimates were calculated using a random-effects model. Twenty-nine (29) observational studies were included with a total of 25,490 patients, 981 of whom developed SVD over a mean follow-up time of 18.5 years. Four (4) factors influencing bioprosthetic SVD were identified: increasing age was a protective factor (per 1-yr increase, HR: 0.91 [95% CI 0.89, 0.94], p
ISSN:1443-9506
1444-2892
DOI:10.1016/j.hlc.2019.09.013