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Tissue valves are increasingly the prosthesis of choice among patients undergoing surgery, and with the advent transcatheter heart valves, their use has climbed significantly.1–7 As such, the uncommon complication of bioprosthetic infective endocarditis is becoming more relevant.1–3 In this issue of Heart, a systematic review and meta-analysis by Anantha-Narayanan et al2 of randomised clinical trials and observational data using propensity matching demonstrated a higher incidence of infective endocarditis in left-sided bioprosthetic compared with mechanical valves. Individually, prior studies did not observe differential rates of infective endocarditis among bioprosthetic and mechanical valves due to insufficient power.2
Proposed theories explaining the higher incidence of infective endocarditis in bioprosthetic valves include differences in rates of degeneration, potential protective effects of metallic surfaces in concert with anticoagulation and antibiotic prophylaxis compliance. Accelerated degeneration of bioprosthetic valves leads to haemodynamic turbulence and potentially endothelial injury, thus facilitating bacterial seeding.1 2 However, bioprosthetic valves have disproportionally higher rates of endocarditis relative to degeneration, implying an alternative explanation to differences in endocarditis susceptibility. Resistance to microbial adherence due to metallic surfaces and prevention of thrombosis may protect mechanical valves.1 Patient compliance with antibiotic prophylaxis is another covariate unaccounted for in this meta-analysis that could have potentially affected the incidence of infective endocarditis.
Does it affect clinical decision making?
Factors influencing valve choice include age, durability, risk …
Contributors We have reviewed the literature on the topic and written the whole manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
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