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(Circulation. 2001;103:1535.)
© 2001 American Heart Association, Inc.

Clinical Investigation and Reports

Prognosis After Aortic Valve Replacement With a Bioprosthesis

Predictions Based on Meta-Analysis and Microsimulation

J. P. A. Puvimanasinghe, MBBS, MSc, MD; E. W. Steyerberg, PhD; J. J. M. Takkenberg, MD; M. J. C. Eijkemans, MSc; L. A van Herwerden, MD, PhD; A. J. J. C. Bogers, MD, PhD; J. D. F. Habbema, PhD

From the Center for Clinical Decision Sciences, Department of Public Health (J.P.A.P., E.W.S., M.J.C.E., J.D.F.H.), and the Department of Cardio-thoracic Surgery (J.J.M.T., L.A.v.H., A.J.J.C.B.), Erasmus University Medical Center, Rotterdam, The Netherlands.

Correspondence to Dr E.W. Steyerberg, Department of Public Health, Ee2091, Erasmus University Medical Center Rotterdam, PO Box 1738, 3000 DR Rotterdam, Netherlands. E-mail steyerberg{at}mgz.fgg.eur.nl

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 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.

Conclusions—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.

Key Words: heart diseases • surgery • valves • meta-analysis • prognosis • survival

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