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Ann Thorac Surg 2003;75:1482-1489
© 2003 The Society of Thoracic Surgeons
a Department of Cardio-Thoracic Surgery, Rotterdam, The Netherlands
b Department of Public Health, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
c Section of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
Accepted for publication November 1, 2002.
* Address reprint requests to Dr Takkenberg, Department of Cardio-Thoracic Surgery, Bd162, Erasmus University Medical Center Rotterdam, PO Box 2040, 3000CA Rotterdam, The Netherlands (Email: takkenberg{at}thch.azr.nl).
Background: Aortic root replacement with cryopreserved allografts is associated with excellent hemodynamics, little endocarditis, low thromboembolic event rates, and no need for anticoagulation. There is, however, concern regarding the long-term durability of this valve substitute, especially in younger patients. Meta-analysis and microsimulation were used to calculate age-specific long-term prognosis after allograft aortic root replacement based on current evidence.
Methods: Our center’s experience with cryopreserved allograft aortic root replacement in 165 adult patients was combined in a meta-analysis with reported and individual results from four other hospitals. Using this information, the microsimulation model predicted age- and gender-specific total and reoperation-free and event-free life expectancy.
Results: The pooled results comprised 629 patients with a total follow-up of 1860 patient-years (range 0 to 12.8 years). Annual risks were 0.6% for thromboembolism, 0.05% for bleeding, 0.5% for endocarditis, and 0.5% for nonstructural valve failure. Structural allograft failure requiring reoperation occurred in 15 patients, and a patient age–specific Weibull function was constructed accordingly. Calculated total life expectancy varied from 27 years in a 25-year-old to 12 years in a 65-year-old male; corresponding actual lifetime risk of reoperation was 89% and 35%, respectively.
Conclusions: Cryopreserved aortic allografts have an age-related limited durability. This results in a considerable lifetime risk of reoperation, especially in young patients. The combination of meta-analysis and microsimulation provides an appropriate tool for estimating individualized long-term outcome after aortic valve replacement and can be useful both for patient counseling and prognostic research purposes.
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