Prognosis after aortic valve replacement with a bioprosthesis: Predictions based on meta-analysis and microsimulation
Bioprostheses are widely used as an aortic valve substitute, but knowledge about prognosis is still incomplete. The purpose of this study was to provide insight into the age-related life expectancy and actual risks of reoperation and valve-related events of patients after aortic valve replacement wi...
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| Veröffentlicht in: | Circulation (New York, N.Y.) N.Y.), 2001-03, Vol.103 (11), p.1535-1541 |
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| creator | PUVIMANASINGHE, J. P. A STEYERBERG, E. W TAKKENBERG, J. J. M EIJKEMANS, M. J. C VAN HERWERDEN, L. A BOGERS, A. J. J. C HABBEMA, J. D. F |
| description | Bioprostheses are widely used as an aortic valve substitute, but knowledge about prognosis is still incomplete. The purpose of this study was to provide insight into the age-related life expectancy and actual risks of reoperation and valve-related events of patients after aortic valve replacement with a porcine bioprosthesis.
We conducted a meta-analysis of 9 selected reports on stented porcine bioprostheses, including 5837 patients with a total follow-up of 31 874 patient-years. The annual rates of valve thrombosis, thromboembolism, hemorrhage, and nonstructural dysfunction were 0.03%, 0.87%, 0.38%, and 0.38%, respectively. The annual rate of endocarditis was estimated at 0.68% for >6 months of implantation and was 5 times as high during the first 6 months. Structural valve deterioration was described with a Weibull model that incorporated lower risks for older patients. These estimates were used to parameterize, calibrate, and validate a mathematical microsimulation model. The model was used to predict life expectancy and actual risks of reoperation and valve-related events after implantation for patients of different ages. For a 65-year-old male, these figures were 11.3 years, 28%, and 47%, respectively.
The combination of meta-analysis with microsimulation enabled a detailed insight into the prognosis after aortic valve replacement with a bioprosthesis for patients of different ages. This information will be useful for patient counseling and clinical decision making. It also could serve as a baseline for the evaluation of newer valve types. |
| doi_str_mv | 10.1161/01.CIR.103.11.1535 |
| format | Article |
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We conducted a meta-analysis of 9 selected reports on stented porcine bioprostheses, including 5837 patients with a total follow-up of 31 874 patient-years. The annual rates of valve thrombosis, thromboembolism, hemorrhage, and nonstructural dysfunction were 0.03%, 0.87%, 0.38%, and 0.38%, respectively. The annual rate of endocarditis was estimated at 0.68% for >6 months of implantation and was 5 times as high during the first 6 months. Structural valve deterioration was described with a Weibull model that incorporated lower risks for older patients. These estimates were used to parameterize, calibrate, and validate a mathematical microsimulation model. The model was used to predict life expectancy and actual risks of reoperation and valve-related events after implantation for patients of different ages. For a 65-year-old male, these figures were 11.3 years, 28%, and 47%, respectively.
The combination of meta-analysis with microsimulation enabled a detailed insight into the prognosis after aortic valve replacement with a bioprosthesis for patients of different ages. This information will be useful for patient counseling and clinical decision making. It also could serve as a baseline for the evaluation of newer valve types.</description><identifier>ISSN: 0009-7322</identifier><identifier>EISSN: 1524-4539</identifier><identifier>DOI: 10.1161/01.CIR.103.11.1535</identifier><identifier>PMID: 11257081</identifier><identifier>CODEN: CIRCAZ</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject>Adolescent ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Animals ; Aortic Valve - surgery ; Biological and medical sciences ; Bioprosthesis ; Calibration ; Computer Simulation ; Decision Support Systems, Clinical ; Female ; Heart Valve Diseases - mortality ; Heart Valve Diseases - surgery ; Heart Valve Prosthesis ; Humans ; Life Expectancy ; Male ; Medical sciences ; Middle Aged ; Models, Biological ; Prognosis ; Reoperation ; Reproducibility of Results ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the heart ; Swine</subject><ispartof>Circulation (New York, N.Y.), 2001-03, Vol.103 (11), p.1535-1541</ispartof><rights>2001 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c370t-869e8b9111fee7ad954d0ab84e3736f4a4106a236cfed4828875e5c9058c8c703</citedby><cites>FETCH-LOGICAL-c370t-869e8b9111fee7ad954d0ab84e3736f4a4106a236cfed4828875e5c9058c8c703</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,3674,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=932915$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/11257081$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>PUVIMANASINGHE, J. P. A</creatorcontrib><creatorcontrib>STEYERBERG, E. W</creatorcontrib><creatorcontrib>TAKKENBERG, J. J. M</creatorcontrib><creatorcontrib>EIJKEMANS, M. J. C</creatorcontrib><creatorcontrib>VAN HERWERDEN, L. A</creatorcontrib><creatorcontrib>BOGERS, A. J. J. C</creatorcontrib><creatorcontrib>HABBEMA, J. D. F</creatorcontrib><title>Prognosis after aortic valve replacement with a bioprosthesis: Predictions based on meta-analysis and microsimulation</title><title>Circulation (New York, N.Y.)</title><addtitle>Circulation</addtitle><description>Bioprostheses are widely used as an aortic valve substitute, but knowledge about prognosis is still incomplete. The purpose of this study was to provide insight into the age-related life expectancy and actual risks of reoperation and valve-related events of patients after aortic valve replacement with a porcine bioprosthesis.
We conducted a meta-analysis of 9 selected reports on stented porcine bioprostheses, including 5837 patients with a total follow-up of 31 874 patient-years. The annual rates of valve thrombosis, thromboembolism, hemorrhage, and nonstructural dysfunction were 0.03%, 0.87%, 0.38%, and 0.38%, respectively. The annual rate of endocarditis was estimated at 0.68% for >6 months of implantation and was 5 times as high during the first 6 months. Structural valve deterioration was described with a Weibull model that incorporated lower risks for older patients. These estimates were used to parameterize, calibrate, and validate a mathematical microsimulation model. The model was used to predict life expectancy and actual risks of reoperation and valve-related events after implantation for patients of different ages. For a 65-year-old male, these figures were 11.3 years, 28%, and 47%, respectively.
The combination of meta-analysis with microsimulation enabled a detailed insight into the prognosis after aortic valve replacement with a bioprosthesis for patients of different ages. This information will be useful for patient counseling and clinical decision making. It also could serve as a baseline for the evaluation of newer valve types.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Age Factors</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Animals</subject><subject>Aortic Valve - surgery</subject><subject>Biological and medical sciences</subject><subject>Bioprosthesis</subject><subject>Calibration</subject><subject>Computer Simulation</subject><subject>Decision Support Systems, Clinical</subject><subject>Female</subject><subject>Heart Valve Diseases - mortality</subject><subject>Heart Valve Diseases - surgery</subject><subject>Heart Valve Prosthesis</subject><subject>Humans</subject><subject>Life Expectancy</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Models, Biological</subject><subject>Prognosis</subject><subject>Reoperation</subject><subject>Reproducibility of Results</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the heart</subject><subject>Swine</subject><issn>0009-7322</issn><issn>1524-4539</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2001</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkFuLFDEQhYMo7rj6B3yQgOBbj6lcOolvMnhZWHARfW6q09VupC9jkl7Zf2_GHfSpOPB9h-Iw9hLEHqCFtwL2h6uvexCq5j0YZR6xHRipG22Uf8x2QgjfWCXlBXuW888aW2XNU3YBII0VDnZsu0nrj2XNMXMcCyWOayox8Duc7ognOk4YaKal8N-x3HLkfVyPac3llqrzjt8kGmIocV0y7zHTwNeFz1SwwQWn-7-9y8DnGKoU523CE_ucPRlxyvTifC_Z948fvh0-N9dfPl0d3l83QVlRGtd6cr0HgJHI4uCNHgT2TpOyqh01ahAtStWGkQbtpHPWkAleGBdcsEJdsjcPvfXlXxvl0s0xB5omXGjdcmdb77yWuoLyATy9mRON3THFGdN9B6I7jd0J6OrYNaqau9PYVXp1bt_6mYb_ynndCrw-A5gDTmPCJcT8j_NK-lr0B1ShiSc</recordid><startdate>20010320</startdate><enddate>20010320</enddate><creator>PUVIMANASINGHE, J. P. A</creator><creator>STEYERBERG, E. W</creator><creator>TAKKENBERG, J. J. M</creator><creator>EIJKEMANS, M. J. 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F</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c370t-869e8b9111fee7ad954d0ab84e3736f4a4106a236cfed4828875e5c9058c8c703</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2001</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Age Factors</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Animals</topic><topic>Aortic Valve - surgery</topic><topic>Biological and medical sciences</topic><topic>Bioprosthesis</topic><topic>Calibration</topic><topic>Computer Simulation</topic><topic>Decision Support Systems, Clinical</topic><topic>Female</topic><topic>Heart Valve Diseases - mortality</topic><topic>Heart Valve Diseases - surgery</topic><topic>Heart Valve Prosthesis</topic><topic>Humans</topic><topic>Life Expectancy</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Models, Biological</topic><topic>Prognosis</topic><topic>Reoperation</topic><topic>Reproducibility of Results</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the heart</topic><topic>Swine</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>PUVIMANASINGHE, J. P. A</creatorcontrib><creatorcontrib>STEYERBERG, E. W</creatorcontrib><creatorcontrib>TAKKENBERG, J. J. M</creatorcontrib><creatorcontrib>EIJKEMANS, M. J. C</creatorcontrib><creatorcontrib>VAN HERWERDEN, L. A</creatorcontrib><creatorcontrib>BOGERS, A. J. J. C</creatorcontrib><creatorcontrib>HABBEMA, J. D. 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F</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prognosis after aortic valve replacement with a bioprosthesis: Predictions based on meta-analysis and microsimulation</atitle><jtitle>Circulation (New York, N.Y.)</jtitle><addtitle>Circulation</addtitle><date>2001-03-20</date><risdate>2001</risdate><volume>103</volume><issue>11</issue><spage>1535</spage><epage>1541</epage><pages>1535-1541</pages><issn>0009-7322</issn><eissn>1524-4539</eissn><coden>CIRCAZ</coden><abstract>Bioprostheses are widely used as an aortic valve substitute, but knowledge about prognosis is still incomplete. The purpose of this study was to provide insight into the age-related life expectancy and actual risks of reoperation and valve-related events of patients after aortic valve replacement with a porcine bioprosthesis.
We conducted a meta-analysis of 9 selected reports on stented porcine bioprostheses, including 5837 patients with a total follow-up of 31 874 patient-years. The annual rates of valve thrombosis, thromboembolism, hemorrhage, and nonstructural dysfunction were 0.03%, 0.87%, 0.38%, and 0.38%, respectively. The annual rate of endocarditis was estimated at 0.68% for >6 months of implantation and was 5 times as high during the first 6 months. Structural valve deterioration was described with a Weibull model that incorporated lower risks for older patients. These estimates were used to parameterize, calibrate, and validate a mathematical microsimulation model. The model was used to predict life expectancy and actual risks of reoperation and valve-related events after implantation for patients of different ages. For a 65-year-old male, these figures were 11.3 years, 28%, and 47%, respectively.
The combination of meta-analysis with microsimulation enabled a detailed insight into the prognosis after aortic valve replacement with a bioprosthesis for patients of different ages. This information will be useful for patient counseling and clinical decision making. It also could serve as a baseline for the evaluation of newer valve types.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>11257081</pmid><doi>10.1161/01.CIR.103.11.1535</doi><tpages>7</tpages></addata></record> |
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| source | Journals@Ovid Ovid Autoload; MEDLINE; American Heart Association Journals; EZB-FREE-00999 freely available EZB journals |
| subjects | Adolescent Adult Age Factors Aged Aged, 80 and over Animals Aortic Valve - surgery Biological and medical sciences Bioprosthesis Calibration Computer Simulation Decision Support Systems, Clinical Female Heart Valve Diseases - mortality Heart Valve Diseases - surgery Heart Valve Prosthesis Humans Life Expectancy Male Medical sciences Middle Aged Models, Biological Prognosis Reoperation Reproducibility of Results Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the heart Swine |
| title | Prognosis after aortic valve replacement with a bioprosthesis: Predictions based on meta-analysis and microsimulation |
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