title: Estimated event-free life expectancy after autograft aortic root replacement in adults.
abstract: BACKGROUND
  Autograft aortic root replacement is an established therapeutic option for young adults with aortic valve disease. Unfortunately, most series are small with a limited follow-up. Meta-analysis and microsimulation modeling were used to predict long-term outcome based on currently available midterm data.
  
  
  METHODS
  We combined our center's experience with autograft aortic root replacement in 85 adult patients in a meta-analysis with reported results of three other hospitals. The outcomes of this meta-analysis were entered in a microsimulation model, calculating (event-free) life expectancy after autograft aortic root replacement.
  
  
  RESULTS
  The pooled results comprised 380 patients with a total follow-up of 1,077 patient-years. Mean age was 37 years (range 16 to 68 years). Male/female ratio was 2.7. Operative mortality was 2.6% (n = 10); during follow-up 6 more patients died. Linearized annual risk estimates were 0.5% for thromboembolism, 0.3% for endocarditis, and 0.4% for nonstructural valve failure. Structural autograft failure requiring reoperation occurred in 5 patients, and a Weibull function was constructed accordingly. Using this information, the microsimulation model predicted age- and gender-specific mean, reoperation-free, and event-free life expectancy.
  
  
  CONCLUSIONS
  Based on current evidence the calculated average autograft-related reoperation-free life expectancy is 16 years. The combination of meta-analysis and microsimulation provides a promising and powerful tool for estimating long-term outcome after aortic valve replacement.
authors.affiliation: Department of Cardiothoracic Surgery, Erasmus Medical Center Rotterdam, The Netherlands. takkenberg@thch.azr.nl
authors.forename: J J
authors.initials: JJ
authors.lastname: Takkenberg
authors.forename: M J
authors.initials: MJ
authors.lastname: Eijkemans
authors.forename: L A
authors.initials: LA
authors.lastname: van Herwerden
authors.forename: E W
authors.initials: EW
authors.lastname: Steyerberg
authors.forename: G L
authors.initials: GL
authors.lastname: Grunkemeier
authors.forename: J D
authors.initials: JD
authors.lastname: Habbema
authors.forename: A J
authors.initials: AJ
authors.lastname: Bogers
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D002423:Cause of Death; D018572:Disease-Free Survival; D005260:Female; D006351:Heart Valves / Q000637:transplantation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D015996:Survival Rate; D014182:Transplantation, Autologous