Objective: This study aimed at calculating and comparing the long-term outcomes of patients after aortic valve replacement with the Carpentier-Edwards bovine pericardial and porcine supraannular bioprostheses using microsimulation. Methods: We conducted a meta-analysis of eight studies on the Carpentier-Edwards pericardial valves (2685 patients, 12,250 patient-years) and five studies on the supraannular valves (3796 patients, 20,127 patient-years) to estimate the occurrence rates of valve-related events. Eighteen-year follow-up data sets were used to construct age-dependent Weibull curves that described their structural valvular deterioration. The estimates were entered into a microsimulation model, which was used to calculate the outcomes of patients after aortic valve replacement. Results: The annual hazard rates for thrombo-embolism after aortic valve replacement were 1.35% and 1.76% for the pericardial and supraannular valves, respectively. For a 65-year-old male, median time to structural valvular deterioration was 20.1 and 22.2 years while the lifetime risk of reoperation due to structural valvular deterioration was 18.3% and 14.0%, respectively. The life expectancy of the patient was 10.8 and 10.9 years and event-free life expectancy 9.0 and 8.8 years, respectively. Conclusions: The microsimulation methodology provides insight into the prognosis of a patient after aortic valve replacement with any given valve type. Both the Carpentier-Edwards pericardial and supraannular valve types perform satisfactorily, especially in elderly patients, and show no appreciable difference in long-term outcomes when implanted in the aortic position.

Aortic valve replacement, Bioprostheses, Prognostic modeling
dx.doi.org/10.1016/j.ejcts.2005.11.037, hdl.handle.net/1765/66170
European Journal of Cardio-Thoracic Surgery
Department of Cardio-Thoracic Surgery

Puvimanasinghe, J.P.A, Takkenberg, J.J.M, Eijkemans, M.J.C, van Herwerden, L.A, Jamieson, W.R.E, Grunkemeier, G.L, … Bogers, A.J.J.C. (2006). Comparison of Carpentier-Edwards pericardial and supraannular bioprostheses in aortic valve replacement. European Journal of Cardio-Thoracic Surgery, 29(3), 374–379. doi:10.1016/j.ejcts.2005.11.037