Does the type of biological valve affect patient outcome?

[ken]

http://icvts.ctsnetjournals.org/cgi...FIRSTINDEX=0&minscore=5000&resourcetype=HWCIT


Interact CardioVasc Thorac Surg 2006;5:398-402. doi:10.1510/icvts.2005.122382
© 2006 European Association of Cardio-Thoracic Surgery

Institutional report - Valves

Does the type of biological valve affect patient outcome?

A. Pieter Kappeteina,*, Johanna J.M. Takkenberga, John P.A. Puvimanasinghea, W.R. Eric Jamiesonb, Marinus Eijkemansc and Ad.J.J.C. Bogersa
a Department of Cardio-Thoracic Surgery and the Erasmus MC, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
b Division of Cardiovascular Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
c Center for Clinical Decision Sciences, Department of Public Health, Erasmus MC, Rotterdam, The Netherlands

*Corresponding author. Tel.: +31 (0) 10 4635412; fax: +31 (0) 10 4633993.

E-mail address: [email protected] (A.P. Kappetein).

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 and median time to structural valvular deterioration. We then used a microsimulation model to calculate age-specific patient survival and reoperation- and event-free life expectancies. The model incorporated the US population mortality and a uniform excess mortality, while the hazards of valve-related events after implantation of the four valve types were estimated from corresponding meta-analysis and primary data. Observed 10-year survival (60?69)-year age group survival and median time to SVD for the different valve types did not differ. Microsimulation calculated, for a 65-year-old male for example, a 10-year survival of 51%, 51%, 53% and 56% for Carpentier-Edwards pericardial and Supra-annular valve, Freestyle and allografts, respectively. Patient life expectancy was 10.8, 10.8, 11.0 and 11.4 years, respectively. Assuming uniform patient characteristics and excess mortality, the observed difference in performance between the four biological valve types is less marked. Patient selection and the timing of operation may explain most of the observed differences in prognosis after aortic valve replacement with biological prostheses.


Key Words: Aortic valve replacement; Bioprosthesis; Microsimulation; Follow-up

 

[RCB]

Short version

Short version

http://icvts.ctsnetjournals.org/cgi...FIRSTINDEX=0&minscore=5000&resourcetype=HWCIT


Interact CardioVasc Thorac Surg 2006;5:398-402. doi:10.1510/icvts.2005.122382
© 2006 European Association of Cardio-Thoracic Surgery

Institutional report - Valves

Does the type of biological valve affect patient outcome?

A. Pieter Kappeteina,*, Johanna J.M. Takkenberga, John P.A. Puvimanasinghea, W.R. Eric Jamiesonb, Marinus Eijkemansc and Ad.J.J.C. Bogersa
a Department of Cardio-Thoracic Surgery and the Erasmus MC, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
b Division of Cardiovascular Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
c Center for Clinical Decision Sciences, Department of Public Health, Erasmus MC, Rotterdam, The Netherlands

*Corresponding author. Tel.: +31 (0) 10 4635412; fax: +31 (0) 10 4633993.

E-mail address: [email protected] (A.P. Kappetein).

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 and median time to structural valvular deterioration. We then used a microsimulation model to calculate age-specific patient survival and reoperation- and event-free life expectancies. The model incorporated the US population mortality and a uniform excess mortality, while the hazards of valve-related events after implantation of the four valve types were estimated from corresponding meta-analysis and primary data. Observed 10-year survival (60?69)-year age group survival and median time to SVD for the different valve types did not differ. Microsimulation calculated, for a 65-year-old male for example, a 10-year survival of 51%, 51%, 53% and 56% for Carpentier-Edwards pericardial and Supra-annular valve, Freestyle and allografts, respectively. Patient life expectancy was 10.8, 10.8, 11.0 and 11.4 years, respectively. Assuming uniform patient characteristics and excess mortality, the observed difference in performance between the four biological valve types is less marked. Patient selection and the timing of operation may explain most of the observed differences in prognosis after aortic valve replacement with biological prostheses.


Key Words: Aortic valve replacement; Bioprosthesis; Microsimulation; Follow-up

No difference!

 

[Marguerite53]

http://icvts.ctsnetjournals.org/cgi...FIRSTINDEX=0&minscore=5000&resourcetype=HWCIT


. Patient selection and the timing of operation may explain most of the observed differences in prognosis after aortic valve replacement with biological prostheses.


Key Words: Aortic valve replacement; Bioprosthesis; Microsimulation; Follow-up

Thus the emphasis so many of us place on not waiting too awfully long to get things done!! That's where I would like to see some change....in a cardiologist's acceptance of the inevitable and in encouraging patients not to wait too long. Of course, a tissue valve that would last longer than 15 years would be nice, too!!

Thanks for that, Ken ..... and yes..... where is BobH?

Marguerite

 

[tobagotwo]

We could wrangle through all the nomenclature, things not considered, and possible prejudicing influences...

But RCB said it in two words: no difference.

Best wishes,

 

[Andyrdj]

howver

howver

It is noteworthy to realise that for older patients the valve survival time is often much longer than 10 years - both Medtronic's older Hancock valve and the C/E Perimount were known to have over 80% freedom (or something near) from explant at 15+ years for patients over 50. the older the patient, the lower the structural deterioration.

See the graphs in this post here - http://www.valvereplacement.com/forums/showthread.php?t=15720. The top graph shows that 10 years, 90% were free from explant, and the bottom (for 40 year old patients) illustrates that 80% of them were free of strutural valve deterioration at 10 years.

As far as I know, the freestyle has not been around more than 10 years, so any comparitive study of its deterioration will still be in the region where very little deterioration has taken place.

This seems to say to me that what'll finish these older patients off is not the valve expiring, rather the damage and ageing of their hearts from before the suurgery (and indeed the surgery itself). Or
perhaps other age related factors? Indeed, it almost suggests that even the hypothetical "perfect valve" wouldn't help that much, perhaps they need stem cell treatment on their heart or something. Whatever - it seems that for them at least the important thing is to get an operation so that their heart can start to heal or at least limit the damage from a faulty valve.

For a younger patient - well, I'm not going to go so far as to say "wait for a better valve" if you need an operation because the damage this can do is obvious.

However, what I do think is that if you are going for tissue you should try and get the most durable one possible, because you are far more likely to live into the region where a high percentage of valves are being explanted. In other words, you don't have this 50% mortality rate to fear, you are likely to outlive the valve.

So Bob H, that 10 favourable 10 year follow up on the Mosaic should be of some cheer to you - I understand you're in fairly good health?

More cheerful certainly than to an unfortunate whose heart tissue is failing them, even though their valve is working fine.