Prognosis after Aortic Valve Replacement with Mechanical Valves and Bioprostheses: Use of Meta-analysis and Microsimulation

Aortic valve replacement (AVR) is a surgical procedure aimed at replacing a diseased aortic valve with a prosthetic device. The prognosis of a patient after AVR depends on many interrelated factors. The objective of this thesis was to further develop and utilize the microsimulation methodology to determine the prognosis of patients after AVR with mechanical valves and bioprostheses, which in turn could assist in the optimal choice of a valve prosthesis for a given patient

Prognosis after aortic valve replacement with a bioprosthesis: predictions based on meta-analysis and microsimulation

BACKGROUND: 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. METHODS AND RESULTS: 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 implantat

Does the type of biological valve affect patient outcome?

Patient background mortality and excess mortality related to aortic valve disease may play a greater role than implanted valve type in explaining the observed survival differences after aortic valve replacement. This study attempts to identify the differences between the performance of selected biological valves, given similar patient characteristics and excess mortality. Four biological valve types, the Carpentier-Edwards pericardial and supra-annular valve, Medtronic Freestyle valve and allografts were used for this analysis. Primary data calculated observed patient-survival an