Table S1. Studies reporting long term outcomes of biological substitute in aortic valve endocarditis (74,75).
| First author (Ref.) | Total sample (N) | Number of patients/endocarditis | Mean follow-up/months | Number of aortic valve substitute implanted or repair | Main findings |
|---|---|---|---|---|---|
| Nappi 2018 (7), JTCVS | 210 | 118 | 162 | CAH [210] | Similar survival at 15 yrs Ao-H (61.3%) vs. XP (62.1%) and vs. MP (60,6%) |
| χ Ao/Mitr-H [11] | 15 yrs freedom from reoperation SVD 89.4% | ||||
| Freedom from IE 98.1% at 20 yrs. MACCEs freedom from event at 15 yrs 50.6% | |||||
| Schaefer 2018 (4), PLoS One | 154 | 35 | 48.7 | SFS [77] (IE 19) | 30-day mortality (SFS 3/77; 3.9% vs. CP 4/77; 5.2%; P=0.699). All-cause mortality (SFS 20.8% vs. CP 14.3%; P=0.397) |
| XP [77] (IE 16) | SVD (5.2% SFS vs. 0% CP; P=0.04) | ||||
| Reoperation due to SVD or PVE (9.1% SFS vs. 1.3% CP; P=0.04) | |||||
| Inferior survival after NVE in re-do surgery in SFS group (HR: 7.63, CI: 1.65±35.25, P=0.009) | |||||
| Ratschiller 2017 (39), Semin Thorac Cardiovasc Surg | 190 | 190 | 144 | Ross Operation | 30 days mortality for the total study population of 2.1%. Survival 93.8% (95% confidence interval [CI]: 90.2-97.7) at 10 years and 86.1% (95% CI: 78.8−94.0) at 20 years |
| Freedom from reoperation on the auto- and CAH 94.1% (95% CI: 83.6−100.0) at 5 years, 87.4% (95% CI: 72.4−100.0) at 10 years, and 71.5% (51.1−100.0) at 15 years | |||||
| Lower incidence of reoperation for autograft endocarditis 0.4% | |||||
| Arabkhani 2016 (10), JTCVS | 353 | 115 | 137 | CAH [115] | 20 yrs survival 40.0% at (95% CI, 32−50%) |
| 20 yrs predicted competing-risks analysis 31% death without reoperation, 39% reoperation, and 30% alive without reoperation. Low incidence of infection relaps (3,96%) and reoperation (2,26%) | |||||
| Flameng 2015 (74), Ann Thorac Surg | 69 | 69 | 96 | CAH [69] | 10 yrs survival 73% |
| 10 years freedom of reoperation 74% | |||||
| Lower incidence of infection relapse and reoperation for IE (4,34%). Higher indicence of reoperation for SVD (18,84%) | |||||
| Bourguignon 2015 (44), Ann Thorac Surg | 2,559 | 111 | 79 | XP [111] | 15 and 20 yrs survival 31.1% and, 14.4% (95% CI). IE early 0.11%; late 0.38%/ [95% CI 0.30–0.48%] |
| (CP bioprosthesis) | 10 and 20 yrs freedom from SVD 94.2%, 48.5%. MST 19.7years (95% CI 18.5% to 21.1%) | ||||
| 20 yrs freedom from reoperation (60 to 70 yrs) 59.6% Cumulative risk of reoperation for SVD HR 0.93 (95% CI 0.92 to 0.94; P<0.001) | |||||
| Johnston 2015 (45), Ann Thorac Surg | 12,569 | 450 | 68 | XP [450] | 76% probability of death before explant for SVD and endocarditis at 20 years |
| (CP bioprosthesis) | Few probabilities of explantation for SVD (5,4%) and endocarditis (1,4%) at 20 years | ||||
| Fukushima 2014 (9), JTCVS | 840 | 101 | 420 | CAH [101] | 35 yrs survival 66%. 35 yrs reoperation rate for SVD 33,9%. 2 pts with CAH for more than 30 yrs |
| Lower incidence of infection relapse and reoperation for IE. Early reinfection 0,2%. Late relapse of IE 5.5% | |||||
| Sénage 2014 (48), Circulation | 617 | “ “ | 44 | XP [617] | 5 yrs survival 69.6% (95% CI, 65.7–73.9). Early SVD. 1-, 2-, and 5-year 0.2% [95% confidence interval (CI), 0.0–0.6], 0.8% (95% CI, 0.0–1.6), and 8.4% (95% CI, 5.3–11.3) |
| Mitroflow (models 12A/LX) | 5-year SVD-free survival 91.6% [95% confidence interval (CI), 88.7–94.7]. 13 patients accelerated SVD | ||||
| Kowert 2012 (21), Eur J Cardiothorac Surg | 363 | 363 | 100 | CAH [363] | Early death 8.9%. Survival 1 year (86%) and 5 years (77,4%) |
| Mean time between CAH implantation and redo operation 8.4±3.6 years | |||||
| Early and late recurrent endocarditis 9% (prior IE) | |||||
| Bekkers 2011 (20), Eur J Cardiothorac Surg | 262 | 96 | 102 | CAH [96] | 30-day mortality 5.7%. Survival 77.0% [95% confidence interval (CI) 71—83%] at 10 years, and 65.1% (95% CI 57–74%) at 14 years. Survival after re-operation |
| 87.1% at 1 year and 79.3% at 9 years | |||||
| Freedom from CAH re-operation 82.9% at 10 years and 55.7% (SE 5.7%) at 14 years. SVD 18.5% and infection relaps 0.7% | |||||
| Musci 2010 (22), JTCVS | 1,136 | 1,136 | 62 | CAH [221] | 10 yrs survival 47.3%±5.6%. Lower incidence (5.4%) of infection relapse and reoperation for IE |
| Lower incidence of reoperation for SVD 8.6% | |||||
| El-Hamamsy 2010 (11), JACC | †166 | 4 | 90 | CAH [76] | SFS less progressive aortic valve dysfunction and a lower need for reoperation (100±0% vs. 90±5%; P=0.02) |
| SFS [90] | 30-day mortality 4.8%. No difference in survival SFS vs CAH (80 +/-5% vs. 77 +/- 6%; P=0.9) | ||||
| David 2008 (75), JTCVS | 357 | 7 | 91 | SPV (T-SPV) bioprosthesis (St Jude Medical, Inc, St Paul, Min) [357] | 12 yrs survival 64%. 12 yrs freedom from SVD 69% (P=0.002) |
| Higher incidence of infection relapse (10% of redo aortic valve replacement) | |||||
| Yankah 2002 (23), EJCTS | 816 | 816 | 60 | CAH [182] | 10 yrs survival 91%. Lower incidence of early (2.7%) and late (3.6%) infection relapse and reoperation for IE (P=0.0001) |
| 10–13 yrs freedom from reoperation for SVD 85% | |||||
| Sabik 2002 (12), Ann Thorac Surg | Ф103 | 103 | 51 | CAH [103] | 30-day mortality 3.9%. Survival at 10 yrs 56%. Few recurrent PVE at >/=2 yrs (peaked at 9 months) |