Outcomes in Elderly Patients with Mechanical Aortic Valve Replacement: Systematic Review and Meta-Analysis

Abstract Background: The current gold standard of care for the majority of patients with severe aortic stenosis is aortic valve replacement (AVR). According to the most recent recommen-dations from the European Society of Cardiology and the European Association of Cardio-Thoracic Surgery, biopros-theses should be taken into consideration as the preferred course of treatment for patients over 65. Nonetheless, both mechanical and biological valve types are regarded as suitable choices for patients between the ages of 60 and 65. (recom-mendation class Il-a). Aim of Study: This study aimed to systematically compare outcomes in elderly patients with surgically implanted me-chanical versus biological aortic prosthesis. Patients and Methods: A comprehensive literature search was performed using the following search engines, Ovid, Medline, Embase, Pubmed, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, American College of Physicians Journal Club, and Database of Abstracts of Review of Effectiveness from their dates of inception to 2022. Results: A total of 4120 patients were analyzed in six articles. Mean age was similar in both groups of patients (61.1±4.3 vs 61.2±4.8 years) in bioprosthetic group and mechanical valve group, respectively. The occurrence of major bleeding was in favour of bioprothetic valve (less major bleeding) With an odds ratio of 0.73 odd and p<0.001. The occurrence of thrombo-embolic manifestation was in favour of bioprosthetic valve (less stroke) with protective effect by 10%. The effect estimate of OR was 0.9. The need for re-operation was in favor of mechanical group with an odds ratio of 3.11. The occurrence of mortality is mildly higher in bioprosthetic group compared to mechanical group with an odds ratio of 1.16. Conclusion: Our analysis therefore supports the current practice of using BVs for patients who are 60 years of age or older, including renal patients on dialysis, even though longer-term data are anticipated.