Ross procedure or mechanical aortic valve, which is the best lifetime option for an 18-year-old? A decision analysis.

Autor:	Sarnaik KS; Case Western Reserve University School of Medicine, Cleveland, Ohio., Hoenig SM; Case Western Reserve University School of Medicine, Cleveland, Ohio., Bakir NH; Department of Pediatric Cardiac Surgery, Cleveland Clinic, Cleveland, Ohio., Hammoud MS; Department of Pediatric Cardiac Surgery, Cleveland Clinic, Cleveland, Ohio., Mahboubi R; Department of Pediatric Cardiac Surgery, Cleveland Clinic, Cleveland, Ohio., Vervoort D; Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada., McCrindle BW; Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada., Welke KF; Division of Pediatric Cardiothoracic Surgery, Atrium Health Levine Children's Hospital, Charlotte, NC., Karamlou T; Department of Pediatric Cardiac Surgery, Cleveland Clinic, Cleveland, Ohio.
Jazyk:	angličtina
Zdroj:	JTCVS open [JTCVS Open] 2023 Nov 11; Vol. 17, pp. 185-214. Date of Electronic Publication: 2023 Nov 11 (Print Publication: 2024).
DOI:	10.1016/j.xjon.2023.10.033
Abstrakt:	Objectives: Identifying the optimal solution for young adults requiring aortic valve replacement (AVR) is challenging, given the variety of options and their lifetime complication risks, impacts on quality of life, and costs. Decision analytic techniques make comparisons incorporating these measures. We evaluated lifetime valve-related outcomes of mechanical aortic valve replacement (mAVR) versus the Ross procedure (Ross) using decision tree microsimulations modeling. Methods: Transition probabilities, utilities, and costs derived from published reports were entered into a Markov model decision tree to explore progression between health states for hypothetical 18-year-old patients. In total, 20,000 Monte Carlo microsimulations were performed to model mortality, quality-adjusted-life-years (QALYs), and health care costs. The incremental cost-effectiveness ratio (ICER) was calculated. Sensitivity analyses was performed to identify transition probabilities at which the preferred strategy switched from baseline. Results: From modeling, average 20-year mortality was 16.3% and 23.2% for Ross and mAVR, respectively. Average 20-year freedom from stroke and major bleeding was 98.6% and 94.6% for Ross, and 90.0% and 82.2% for mAVR, respectively. Average individual lifetime (60 postoperative years) utility (28.3 vs 23.5 QALYs) and cost ($54,233 vs $507,240) favored Ross over mAVR. The average ICER demonstrated that each QALY would cost $95,345 more for mAVR. Sensitivity analysis revealed late annual probabilities of autograft/left ventricular outflow tract disease and homograft/right ventricular outflow tract disease after Ross, and late death after mAVR, to be important ICER determinants. Conclusions: Our modeling suggests that Ross is preferred to mAVR, with superior freedom from valve-related morbidity and mortality, and improved cost-utility for young adults requiring aortic valve surgery. Competing Interests: T.K. serves as a consultant for Edwards Lifesciences. All other authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest. (© 2023 The Author(s).)
Databáze:	MEDLINE
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