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Patient outcome after aortic valve replacement with a mechanical or biological prosthesis: Weighing lifetime anticoagulant-related event risk against.

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Presentation on theme: "Patient outcome after aortic valve replacement with a mechanical or biological prosthesis: Weighing lifetime anticoagulant-related event risk against."— Presentation transcript:

1 Patient outcome after aortic valve replacement with a mechanical or biological prosthesis: Weighing lifetime anticoagulant-related event risk against reoperation risk  Martijn W.A. van Geldorp, MD, MSc, W.R. Eric Jamieson, MD, A. Pieter Kappetein, MD, PhD, Jian Ye, MD, Guy J. Fradet, MD, Marinus J.C. Eijkemans, PhD, Gary L. Grunkemeier, PhD, Ad J.J.C. Bogers, MD, PhD, Johanna J.M. Takkenberg, MD, PhD  The Journal of Thoracic and Cardiovascular Surgery  Volume 137, Issue 4, Pages e5 (April 2009) DOI: /j.jtcvs Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

2 Figure 1 Life expectancy in men of different ages in British Columbia (BC), Canada, the United Kingdom (UK), and the United States (US) versus life expectancy after AVR in British Columbia and the United States. LE, Life expectancy; MP, mechanical prosthesis; BP, biological prosthesis. The Journal of Thoracic and Cardiovascular Surgery  , e5DOI: ( /j.jtcvs ) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

3 Figure 2 Lifetime risks of reoperation and bleeding after AVR with mechanical and bioprostheses. BP, Bioprosthesis; MP, mechanical prosthesis. The Journal of Thoracic and Cardiovascular Surgery  , e5DOI: ( /j.jtcvs ) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

4 Figure 3 Event-free life expectancy (with 68% confidence limits in grey) after AVR with mechanical and bioprostheses in the United States. MP, Mechanical prosthesis; BP, biological prosthesis; EFLE, event-free life expectancy; uCL, upper confidence limit; lCL, lower confidence limit. The Journal of Thoracic and Cardiovascular Surgery  , e5DOI: ( /j.jtcvs ) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

5 Internal validation. A, Simulated survival of 58-year-old patients who received mechanical bioprostheses and 70-year-old patients who received bioprostheses versus total observed survival in the biological and mechanical prostheses groups of the Vancouver dataset. B, Simulated survival of 55-, 65-, and 75-year-old male patients with a bioprosthesis versus the bioprosthesis group of the Vancouver dataset, subdivided in age categories. C, Simulated survival of 55-, 65-, and 75-year-old male patients with a mechanical prosthesis versus the mechanical prosthesis group of the Vancouver dataset, subdivided in age categories. MP, mechanical prosthesis; BP, biological prosthesis. The Journal of Thoracic and Cardiovascular Surgery  , e5DOI: ( /j.jtcvs ) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

6 External validation. A, Simulated survival of 55-, 65-, and 75-year-old male patients with a bioprosthesis versus the observed survival in the Portland dataset, subdivided in age categories. B, Simulated survival of 55-, 65-, and 75-year-old male patients with a mechanical prosthesis versus the observed survival in the United Kingdom Heart Valve Registry mechanical dataset, subdivided in age categories. UKHVR, United Kingdom Heart Valve Registry. The Journal of Thoracic and Cardiovascular Surgery  , e5DOI: ( /j.jtcvs ) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

7 Event -free life expectancy for men at different ages of valve implantation. A, Event-free life expectancy for men with a mechanical valve (solid lines) versus a bioprosthesis (dotted lines). Black lines represent the United States population; grey lines represent the population in British Columbia, Canada. Background mortality changes among different populations, which has an effect on absolute event-free life expectancy but hardly any effect on the age cutoff point at which a bioprosthesis is preferable over a mechanical prosthesis. B, Detail of Figures 3 and E3, A. The crossing points of the 68% confidence limits around the event-free life expectancy curves demarcate the area in which the real event-free life expectancy age cutoff point lies (with a 95% certainty). MP, Mechanical prosthesis; BP, biological prosthesis. EFLE, event-free life expectancy. The Journal of Thoracic and Cardiovascular Surgery  , e5DOI: ( /j.jtcvs ) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

8 Actual versus actuarial analysis of all-cause reoperation and reoperation for SVD in the biological group of the Vancouver dataset. SVD, Structural valve deterioration. The Journal of Thoracic and Cardiovascular Surgery  , e5DOI: ( /j.jtcvs ) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

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