Outcomes After Bioprosthetic Versus Mechanical Mitral Valve Replacement for Infective Endocarditis in the United States

Authors

Katie J Hogan
Christopher B Sylvester
Matthew J Wall
Todd K Rosengart
Joseph S Coselli
Marc R Moon
Subhasis Chatterjee
Ravi K Ghanta

Publication Date

2-1-2024

Journal

JTCVS Open

DOI

10.1016/j.xjon.2023.11.019

PMID

38420540

PMCID

PMC10897669

PubMedCentral® Posted Date

12-3-2023

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes

Keywords

endocarditis, mitral valve replacement, readmissions

Abstract

Objective

In patients who underwent mitral valve replacement for infectious endocarditis, we evaluated the association of prosthesis choice with readmission rates and causes (the primary outcomes), as well as with in-hospital mortality, cost, and length of stay (the secondary outcomes).

Methods

Patients with infectious endocarditis who underwent isolated mitral valve replacement from January 2016 to December 2018 were identified in the United States Nationwide Readmissions Database and stratified by valve type. Propensity score matching was used to compare adjusted outcomes.

Results

A weighted total of 4206 patients with infectious endocarditis underwent bioprosthetic mitral valve replacement (n = 3132) and mechanical mitral valve replacement (n = 1074) during the study period. Patients in the bioprosthetic mitral valve replacement group were older than those in the mechanical mitral valve replacement group (median 57 vs 46 y, P < .001). After propensity matching, the bioprosthetic mitral valve replacement group (n = 1068) had similar in-hospital mortality, length of stay, and costs compared with the mechanical mitral valve replacement group (n = 1056). Overall, 90-day readmission rates were high (28.9%) and comparable for bioprosthetic mitral valve replacement (30.5%) and mechanical mitral valve replacement (27.5%, P = .4). Likewise, there was no difference in readmissions over a calendar year by prosthesis type. Readmissions for infection and bleeding were common for both bioprosthetic mitral valve replacement and mechanical mitral valve replacement groups.

Conclusions

Outcomes and readmission rates were similar for mechanical mitral valve replacement and bioprosthetic mitral valve replacement in infectious endocarditis, suggesting that valve choice should not be determined by endocarditis status. Additionally, strategies to mitigate readmission for infection and bleeding are needed for both groups.