Comparison of outcomes after aortic valve replacement with a mechanical valve or a bioprosthesis using microsimulation
Comparison of outcomes after aortic valve replacement with a mechanical valve or a bioprosthesis using microsimulation
复制标题
DOI：
10.1136/hrt.2003.013102
复制
发表时间：
2004-10-01
期刊：
影响因子：
5.7
通讯作者：
Bogers, AJJC
中科院分区：
文献类型：
--
作者：
Puvimanasinghe, JPA;Takkenberg, JJM;Bogers, AJJC
背景：机械瓣膜和生物假体广泛用于主动脉瓣置换术。尽管之前的随机研究表明两种类型瓣膜植入后的结果没有显着差异，但对主动脉瓣置换后结果的了解并不完整。 目的：预测双叶机械瓣膜和带支架猪生物假体主动脉瓣置换术后患者的年龄和性别特异性结果，并为假体的选择提供循证支持。 方法：对已发表的双叶机械瓣膜初次主动脉瓣置换术结果进行荟萃分析（九份报告， 4274 名患者，25726 患者年）和带支架猪生物假体（13 份报告，9007 名患者，54151 患者年）用于估计术后瓣膜相关事件及其结果的年度风险。这些估计值被输入微观模拟模型，用于计算主动脉瓣置换术后年龄和性别的具体结果。结果：一名 65 岁男性植入机械瓣膜或生物假体后的预期寿命 (LE) 和无事件预期寿命 (EFLE) 分别为 10.4 和 10.7 年以及 7.7 和 8.4 年。机械瓣膜的终生风险中至少发生一次瓣膜相关事件的风险为 48%，而生物瓣膜的风险为 44%。对于 LE 和 EFLE，两种瓣膜类型之间的年龄交叉点分别为 59 岁和 60 岁。 结论：基于荟萃分析的微观模拟提供了对主动脉瓣置换术后长期结果的深入了解，并表明目前推荐的植入生物假体的年龄阈值可以进一步降低。
Background: Mechanical valves and bioprostheses are widely used for aortic valve replacement. Though previous randomised studies indicate that there is no important difference in outcome after implantation with either type of valve, knowledge of outcomes after aortic valve replacement is incomplete.Objective: To predict age and sex specific outcomes of patients after aortic valve replacement with bileaflet mechanical valves and stented porcine bioprostheses, and to provide evidence based support for the choice of prosthesis.Methods: Meta-analysis of published results of primary aortic valve replacement with bileaflet mechanical prostheses ( nine reports, 4274 patients, and 25 726 patient-years) and stented porcine bioprostheses ( 13 reports, 9007 patients, and 54 151 patient-years) was used to estimate the annual risks of postoperative valve related events and their outcomes. These estimates were entered into a microsimulation model, which was employed to calculate age and sex specific outcomes after aortic valve replacement.Results: Life expectancy ( LE) and event-free life expectancy (EFLE) for a 65 year old man after implantation with a mechanical valve or a bioprosthesis were 10.4 and 10.7 years and 7.7 and 8.4 years, respectively. The lifetime risk of at least one valve related event for a mechanical valve was 48%, and for a bioprosthesis, 44%. For LE and EFLE, the age crossover point between the two valve types was 59 and 60 years, respectively.Conclusions: Meta-analysis based microsimulation provides insight into the long term outcome after aortic valve replacement and suggests that the currently recommended age threshold for implanting a bioprosthesis could be lowered further.