Prognosis after aortic root replacement with cryopreserved allografts in adults.
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.
Takkenberg
Johanna J M
JJ
Department of Cardio-Thoracic Surgery, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands. takkenberg@thch.azr.nl
Eijkemans
Marinus J C
MJ
van Herwerden
Lex A
LA
Steyerberg
Ewout W
EW
Lane
Mary M
MM
Elkins
Ronald C
RC
Habbema
J Dik F
JD
Bogers
Ad J J C
AJ
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000637:transplantation*; D015925:Cryopreservation; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D011183:Postoperative Complications; D011379:Prognosis; D016016:Proportional Hazards Models; D011475:Prosthesis Failure; D012086:Reoperation; D012307:Risk Factors