Comparison of Carpentier-Edwards pericardial and supraannular bioprostheses in aortic valve replacement.
OBJECTIVE
This study aimed at calculating and comparing the long-term outcomes of patients after aortic valve replacement with the Carpentier-Edwards bovine pericardial and porcine supraannular bioprostheses using microsimulation.


METHODS
We conducted a meta-analysis of eight studies on the Carpentier-Edwards pericardial valves (2,685 patients, 12,250 patient-years) and five studies on the supraannular valves (3,796 patients, 20,127 patient-years) to estimate the occurrence rates of valve-related events. Eighteen-year follow-up data sets were used to construct age-dependent Weibull curves that described their structural valvular deterioration. The estimates were entered into a microsimulation model, which was used to calculate the outcomes of patients after aortic valve replacement.


RESULTS
The annual hazard rates for thrombo-embolism after aortic valve replacement were 1.35% and 1.76% for the pericardial and supraannular valves, respectively. For a 65-year-old male, median time to structural valvular deterioration was 20.1 and 22.2 years while the lifetime risk of reoperation due to structural valvular deterioration was 18.3% and 14.0%, respectively. The life expectancy of the patient was 10.8 and 10.9 years and event-free life expectancy 9.0 and 8.8 years, respectively.


CONCLUSIONS
The microsimulation methodology provides insight into the prognosis of a patient after aortic valve replacement with any given valve type. Both the Carpentier-Edwards pericardial and supraannular valve types perform satisfactorily, especially in elderly patients, and show no appreciable difference in long-term outcomes when implanted in the aortic position.
Puvimanasinghe
John P A
JP
Department of Cardio-thoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
Takkenberg
Johanna J M
JJ
Eijkemans
Marinus J C
MJ
van Herwerden
Lex A
LA
Jamieson
W R Eric
WR
Grunkemeier
Gary L
GL
Habbema
J Dik F
JD
Bogers
Ad J J C
AJ
D000368:Aged; D000818:Animals; D001021:Aortic Valve / Q000601:surgery*; D001705:Bioprosthesis / Q000009:adverse effects; D002417:Cattle; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013552:Swine; D013923:Thromboembolism / Q000209:etiology; D016896:Treatment Outcome