Ann Thorac Surg 2000;70:790-791
© 2000 The Society of Thoracic Surgeons
Discussion
Discussion
Discussion
DR LAWRENCE H. COHEN (Boston, MA): It is a very provocative subject you have brought us today. To your credit, you engaged one of the Olympians of statistical treatment of valve data, Dr Grunkemeier, to independently review your data and you did not exclude the "sicker" patients in your study. If I understood it, the main point in this nonrandomized, nonprospective, non-same surgeon study is that if you put in a stentless valve, your patients will live longer than if you put in a first-generation porcine valve, which is the valve that was compared with the stentless valve. Perhaps there is an implication here that this may aid you in survival versus all stented biological valves.
Although I enjoyed your presentation very much and I am impressed with the elegance of your statistics, I have had the chance to review your manuscript, which was beautifully done as well, and the data of other comparative series, and I have to disagree with the conclusion based on what you presented us today.
As you know, long-term survival after valve operations is an exceedingly complex analysis. You have nicely compared the preoperative demographics, including the presence of coronary disease and reoperations. In your paper, however, and we are now talking about the era of 1993 to 1997, as you pointed out, the operative mortality in both groups was higher than I would have expected: 8% in your personal series of the stentless valve and 12% in a group of stented porcine valves. I . . . [Full Text of this Article]
Related Article
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Survival advantage of stentless aortic bioprostheses
- Stephen Westaby, Matthew Horton, Xu Yu Jin, Takahiro Katsumata, Omar Ahmed, Satoshi Saito, Hui-Hua Li, and Gary L. Grunkemeier
Ann. Thorac. Surg. 2000 70: 785-791.
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Copyright © 2000 by The Society of Thoracic Surgeons.
