Work

Are Homografts Superior to Prosthetic Valves in Destructive Aortic Endocarditis? A Systematic Review and Pairwise Meta‐Analysis of Early–Midterm Outcomes

Year: 2026

Type: review

Study designs: Systematic Review, Meta-Analysis

Abstract: Background Destructive aortic endocarditis (DAE) requires complex surgery. Homografts are traditional gold standards, but emerging evidence questions their superiority over prosthetic valves. This systematic review and pairwise meta‐analysis compare early–midterm outcomes. Methods A comprehensive search of PubMed, Embase, Scopus, and Cochrane (1990–2025) identified studies comparing homografts, mechanical, and bioprosthetic valves for DAE. Outcomes included mortality, reoperation, stroke, reinfection, and midterm survival. Pairwise meta‐analysis and Pearson’s correlation were applied. Results Sixteen studies (9948 patients) were included (homograft n = 1359; mechanical n = 2717; biological n = 5872). The mean age was 53.5 years, and 74.9% were male. No significant differences were observed in 30‐day mortality (homograft vs mechanical: OR 1.31, 95% CI 0.99–1.72; vs biological: OR 1.15, 95% CI 0.73–1.81), midterm survival (RR 1.00, 95% CI 0.92–1.09; RR 1.06, 95% CI 0.88–1.28), or reinfection (homograft vs mechanical: RR 0.99, 95% CI 0.82–1.19; vs biological: RR 0.77, 95% CI 0.44–1.36). Reoperation was significantly higher with homografts versus mechanical (OR 1.58, 95% CI 1.17–2.14) and biological valves (OR 1.45, 95% CI 1.22–1.72), with no heterogeneity ( I 2 = 0%). Stroke risk was comparable across all comparisons, with nonsignificant numerical trends favoring homografts: homograft vs mechanical (OR 0.86, 95% CI 0.37–1.20), homograft vs biological (OR 0.65, 95% CI 0.30–1.41), and mechanical vs biological (OR 0.99, 95% CI 0.80–1.23). Unadjusted pooled proportions suggested higher early mortality with homografts (19.1%) compared to mechanical (16.8%) and biological (15.1%) valves, though these differences were not statistically significant in adjusted pairwise meta‐analyses. Conclusion Homografts do not demonstrate definitive superiority for DAE. While nonsignificant numerical trends toward lower stroke rates were observed with homografts, no statistically significant benefits were confirmed for mortality, reinfection, or midterm survival. Homografts were associated with significantly higher reoperation rates without a survival advantage. Valve selection requires patient‐tailored balancing of infection control, durability, and procedural risk.

Source: Journal of Cardiac Surgery

DOI: 10.1155/jocs/8734329