ATS
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Gary L. Grunkemeier
Charles A.S. Marrin
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Birkmeyer, N. J.O.
Right arrow Articles by O’Connor, G. T.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Birkmeyer, N. J.O.
Right arrow Articles by O’Connor, G. T.

Ann Thorac Surg 2000;70:1946-1952
© 2000 The Society of Thoracic Surgeons

Original article: cardiovascular

Prosthetic valve type for patients undergoing aortic valve replacement: a decision analysis1

Nancy J.O. Birkmeyer, PhDa,c,d, John D. Birkmeyer, MDa,d, Anna N.A. Tosteson, ScDb,c, Gary L. Grunkemeier, PhDe, Charles A.S. Marrin, MB, BSa, Gerald T. O’Connor, DScb,c

a Department of Surgery, Dartmouth Medical School, Hanover, New Hampshire, USA
b Department of Medicine, Dartmouth Medical School, Hanover, New Hampshire, USA
c Center For the Evaluative Clinical Sciences, Dartmouth Medical School, Hanover, New Hampshire, USA
d Veterans Affairs Medical Center, White River Junction, Vermont, USA
e Medical Data Research Center, Providence Health System, Portland, Oregon, USA

Accepted for publication June 9, 2000.

Address reprint requests to Dr Birkmeyer, Surgical Outcomes Assessment Program, Department of Surgery, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH 03756
e-mail: nancyj.birkmeyer{at}dartmouth.edu

Background. In two large, randomized, clinical trials long-term survival after aortic valve replacement (AVR) was similar for patients receiving tissue and mechanical aortic heart valve prostheses. Higher bleeding rates among patients with mechanical valves, who must receive permanent oral anticoagulation to prevent thromboembolism, were offset by higher reoperation rates for valve degeneration among patients with tissue valves. Because the average age of patients undergoing AVR and clinical practices have changed considerably since the randomized clinical trials were conducted, we performed a decision analysis to reassess the optimal valve type for patients undergoing AVR.

Methods. We used a Markov state-transition model to simulate the occurrence of valve-related events and life expectancy for patients undergoing AVR. Probabilities of clinical events and mortality were derived from the randomized clinical trials and large follow-up studies.

Results. Although the two valve types were associated with similar life expectancy in 60-year-old patients (mean age of patients in the randomized clinical trials), tissue valves were associated with greater life expectancy than mechanical valves (10.7 versus 11.1 years) in 70-year-old patients (currently mean age of AVR patients). For 70-year-old patients, the effects of major bleeding complications (24%) with mechanical valves substantially outweighed those of reoperation for valve failure (12%) with tissue valves at 12 years. Of the clinical practice changes assessed, the recommended valve type was most sensitive to changes in bleeding rates with anticoagulation. However, bleeding rates would have to be 68% lower than those reported in the European randomized clinical trial to affect the recommended valve type for 70-year-old patients. Reoperation rates would have to be five times higher, and mortality rates at reoperation would have to be four times higher to affect the recommended valve type for 70-year-old patients.

Conclusions. Although mechanical valves are preferred for AVR patients less than 60 years old, most patients currently undergoing AVR are elderly and would benefit more from tissue valves.




This article has been cited by other articles:


Home page
 HeartHome page
E B Schelbert, M S Vaughan-Sarrazin, K F Welke, and G E Rosenthal
Valve type and long-term outcomes after aortic valve replacement in older patients
Heart, September 1, 2008; 94(9): 1181 - 1188.
[Abstract] [Full Text] [PDF]

Home page
 Card Surg AdultHome page
N. D. Desai and G. T. Christakis
Bioprosthetic Aortic Valve Replacement: Stented Pericardial and Porcine Valves
Card. Surg. Adult, January 1, 2008; 3(2008): 857 - 894.
[Full Text]

Home page
 Card Surg AdultHome page
J. P. Greelish, R. M. Ahmad, J. M. Balaguer, M. R. Petracek, and J. G. Byrne
Reoperative Valve Surgery
Card. Surg. Adult, January 1, 2008; 3(2008): 1159 - 1174.
[Full Text]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
M. W.A. van Geldorp, W.R. E. Jamieson, A. P. Kappetein, J. P.A. Puvimanasinghe, M. J.C. Eijkemans, G. L. Grunkemeier, J. J.M. Takkenberg, and A. J.J.C. Bogers
Usefulness of microsimulation to translate valve performance into patient outcome: Patient prognosis after aortic valve replacement with the Carpentier Edwards supra-annular valve
J. Thorac. Cardiovasc. Surg., September 1, 2007; 134(3): 702 - 709.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
G. L. Grunkemeier, R. Jin, M. J.C. Eijkemans, and J. J.M. Takkenberg
Actual and Actuarial Probabilities of Competing Risks: Apples and Lemons
Ann. Thorac. Surg., May 1, 2007; 83(5): 1586 - 1592.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
O. Lund and M. Bland
Risk-corrected impact of mechanical versus bioprosthetic valves on long-term mortality after aortic valve replacement
J. Thorac. Cardiovasc. Surg., July 1, 2006; 132(1): 20 - 26.
[Abstract] [Full Text] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
J. P.A. Puvimanasinghe, J. J.M. Takkenberg, M. J.C. Eijkemans, L. A. van Herwerden, W.R. E. Jamieson, G. L. Grunkemeier, J. D. F. Habbema, and A. J.J.C. Bogers
Comparison of Carpentier-Edwards pericardial and supraannular bioprostheses in aortic valve replacement
Eur. J. Cardiothorac. Surg., March 1, 2006; 29(3): 374 - 379.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
E. B. Schelbert, G. E. Rosenthal, K. F. Welke, and M. S. Vaughan-Sarrazin
Treatment Variation in Older Black and White Patients Undergoing Aortic Valve Replacement
Circulation, October 11, 2005; 112(15): 2347 - 2353.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
J. P.A. Puvimanasinghe, J. J.M. Takkenberg, M. J.C. Eijkemans, E. W. Steyerberg, L. A. van Herwerden, G. L. Grunkemeier, J. D. F. Habbema, and A. J.J.C. Bogers
Prognosis After Aortic Valve Replacement With the Carpentier-Edwards Pericardial Valve: Use of Microsimulation
Ann. Thorac. Surg., September 1, 2005; 80(3): 825 - 831.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
E. B. Schelbert, M. S. Vaughan-Sarrazin, K. F. Welke, and G. E. Rosenthal
Hospital Volume and Selection of Valve Type in Older Patients Undergoing Aortic Valve Replacement Surgery in the United States
Circulation, May 3, 2005; 111(17): 2178 - 2182.
[Abstract] [Full Text] [PDF]

Home page
 HeartHome page
J P A Puvimanasinghe, J J M Takkenberg, M B Edwards, M J C Eijkemans, E W Steyerberg, L A van Herwerden, K M Taylor, G L Grunkemeier, J D F Habbema, and A J J C Bogers
Comparison of outcomes after aortic valve replacement with a mechanical valve or a bioprosthesis using microsimulation
Heart, October 1, 2004; 90(10): 1172 - 1178.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
W. T. Smith IV, T. B. Ferguson Jr, T. Ryan, C. K. Landolfo, and E. D. Peterson
Should coronary artery bypass graft surgery patients with mild or moderate aortic stenosis undergo concomitant aortic valve replacement?: A decision analysis approach to the surgical dilemma
J. Am. Coll. Cardiol., September 15, 2004; 44(6): 1241 - 1247.
[Abstract] [Full Text] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
J. P.A. Puvimanasinghe, J. J.M. Takkenberg, M. J.C. Eijkemans, E. W. Steyerberg, L. A. van Herwerden, G. L. Grunkemeier, J. D. F. Habbema, and A. J.J.C. Bogers
Choice of a mechanical valve or a bioprosthesis for AVR: does CABG matter?
Eur. J. Cardiothorac. Surg., May 1, 2003; 23(5): 688 - 695.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
J. J.M. Takkenberg, J. P.A. Puvimanasinghe, and G. L. Grunkemeier
Simulation models to predict outcome after aortic valve replacement
Ann. Thorac. Surg., May 1, 2003; 75(5): 1372 - 1376.
[Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
J. J.M. Takkenberg, M. J.C. Eijkemans, L. A. van Herwerden, E. W. Steyerberg, M. M. Lane, R. C. Elkins, J.D. F. Habbema, and A. J.J.C. Bogers
Prognosis after aortic root replacement with cryopreserved allografts in adults
Ann. Thorac. Surg., May 1, 2003; 75(5): 1482 - 1489.
[Abstract] [Full Text] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
J. G. Byrne, T. Gudbjartsson, A. N. Karavas, T. Mihaljevic, B. J. Phillips, S. F. Aranki, J. D. Rawn, and L. H. Cohn
Biological vs. mechanical aortic root replacement
Eur. J. Cardiothorac. Surg., March 1, 2003; 23(3): 305 - 310.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
P. P. Urbanski, A. Diegeler, A. Siebel, M. Zacher, and R. W. Hacker
Valved stentless composite graft: clinical outcomes and hemodynamic characteristics
Ann. Thorac. Surg., February 1, 2003; 75(2): 467 - 471.
[Abstract] [Full Text] [PDF]

Home page
 Card Surg AdultHome page
J. G. Byrne, B. J. Phillips, and L. H. Cohn
Reoperative Valve Surgery
Card. Surg. Adult, January 1, 2003; 2(2003): 1047 - 1056.
[Full Text]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
E. G. Butchart, N. Payne, H.-H. Li, K. Buchan, K. Mandana, and G. L. Grunkemeier
Better anticoagulation control improves survival after valve replacement
J. Thorac. Cardiovasc. Surg., April 1, 2002; 123(4): 715 - 723.
[Abstract] [Full Text]

Home page
 Eur Heart J SupplHome page
J.J.M. Takkenberg, J.P.A. Puvimanasinghe, L.A. van Herwerden, E.W. Steyerberg, M.J.C. Eijkemans, J.D.F Habbema, and A.J.J.C. Bogers
Prognosis after aortic valve replacement with St. Jude Medical bileaflet prostheses: impact on outcome of varying thromboembolic and bleeding hazards
Eur. Heart J. Suppl., December 1, 2001; 3(suppl_Q): Q27 - Q32.
[Abstract] [PDF]

Home page
 Eur Heart J SupplHome page
C. Huth, A. Friedl, A. Rost, and for the GELIA Study Investigator Group
Intensity of oral anticoagulation after implantation of St. Jude Medical aortic prosthesis: analysis of the GELIA Database (GELIA 4)
Eur. Heart J. Suppl., December 1, 2001; 3(suppl_Q): Q33 - Q38.
[Abstract] [PDF]

Home page
 Ann. Thorac. Surg.Home page
J. J.M. Takkenberg, M. J.C. Eijkemans, and E. W. Steyerberg
Simulation techniques to support prosthetic valve choice in aortic valve replacement
Ann. Thorac. Surg., November 1, 2001; 72(5): 1795 - 1795.
[Full Text] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 2000 by The Society of Thoracic Surgeons.