Comparison of outcomes after aortic valve replacement with a mechanical valve or a bioprosthesis using microsimulation
| Autor: | L. A. Van Herwerden, Ewout W. Steyerberg, Maria-Benedicta Edwards, John P.A. Puvimanasinghe, J. D. F. Habbema, Kenneth M. Taylor, Grunkemeier Gl, M.J.C. Eijkemans, Johanna J.M. Takkenberg, A. J. J. C. Bogers |
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| Přispěvatelé: | Cardiothoracic Surgery, Public Health |
| Rok vydání: | 2004 |
| Předmět: |
Aortic valve
Male medicine.medical_specialty Swine medicine.medical_treatment Aortic Valve Insufficiency Microsimulation Prosthesis Mechanical valve Microsimulation model Aortic valve replacement Internal medicine medicine Animals Humans Computer Simulation Aged Bioprosthesis Heart Valve Prosthesis Implantation Interventional Cardiology and Surgery Interventional cardiology business.industry Middle Aged medicine.disease Surgery medicine.anatomical_structure Treatment Outcome Aortic Valve Heart Valve Prosthesis Cardiology cardiovascular system Lifetime risk Female Stents Cardiology and Cardiovascular Medicine business |
| Zdroj: | Heart, 90, 1172-1178. BMJ Publishing Group |
| ISSN: | 1468-201X 1355-6037 |
| DOI: | 10.1136/hrt.2003.013102 |
| Popis: | BACKGROUND: Mechanical valves and bioprostheses are widely used for aortic valve replacement. Though previous randomised studies indicate that there is no important difference in outcome after implantation with either type of valve, knowledge of outcomes after aortic valve replacement is incomplete. OBJECTIVE: To predict age and sex specific outcomes of patients after aortic valve replacement with bileaflet mechanical valves and stented porcine bioprostheses, and to provide evidence based support for the choice of prosthesis. METHODS: Meta-analysis of published results of primary aortic valve replacement with bileaflet mechanical prostheses (nine reports, 4274 patients, and 25,726 patient-years) and stented porcine bioprostheses (13 reports, 9007 patients, and 54,151 patient-years) was used to estimate the annual risks of postoperative valve related events and their outcomes. These estimates were entered into a microsimulation model, which was employed to calculate age and sex specific outcomes after aortic valve replacement. RESULTS: Life expectancy (LE) and event-free life expectancy (EFLE) for a 65 year old man after implantation with a mechanical valve or a bioprosthesis were 10.4 and 10.7 years and 7.7 and 8.4 years, respectively. The lifetime risk of at least one valve related event for a mechanical valve was 48%, and for a bioprosthesis, 44%. For LE and EFLE, the age crossover point between the two valve types was 59 and 60 years, respectively. CONCLUSIONS: Meta-analysis based microsimulation provides insight into the long term outcome after aortic valve replacement and suggests that the currently recommended age threshold for implanting a bioprosthesis could be lowered further. |
| Databáze: | OpenAIRE |
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