Prognosis after surgical replacement with a bioprosthetic aortic valve in patients with severe symptomatic aortic stenosis: systematic review of observational studies.
OBJECTIVE
To determine the frequency of survival, stroke, atrial fibrillation, structural valve deterioration, and length of hospital stay after surgical replacement of an aortic valve (SAVR) with a bioprosthetic valve in patients with severe symptomatic aortic stenosis.


METHODS
Systematic review and meta-analysis of observational studies.


METHODS
Medline, Embase, PubMed (non-Medline records only), Cochrane Database of Systematic Reviews, and Cochrane CENTRAL from 2002 to June 2016.


METHODS
Eligible observational studies followed patients after SAVR with a bioprosthetic valve for at least two years.


METHODS
Reviewers, independently and in duplicate, evaluated study eligibility, extracted data, and assessed risk of bias for patient important outcomes. We used the GRADE system to quantify absolute effects and quality of evidence. Published survival curves provided data for survival and freedom from structural valve deterioration, and random effect models provided the framework for estimates of pooled incidence rates of stroke, atrial fibrillation, and length of hospital stay.


RESULTS
In patients undergoing SAVR with a bioprosthetic valve, median survival was 16 years in those aged 65 or less, 12 years in those aged 65 to 75, seven years in those aged 75 to 85, and six years in those aged more than 85. The incidence rate of stroke was 0.25 per 100 patient years (95% confidence interval 0.06 to 0.54) and atrial fibrillation 2.90 per 100 patient years (1.78 to 4.79). Post-SAVR, freedom from structural valve deterioration was 94.0% at 10 years, 81.7% at 15 years, and 52% at 20 years, and mean length of hospital stay was 12 days (95% confidence interval 9 to 15).


CONCLUSIONS
Patients with severe symptomatic aortic stenosis undergoing SAVR with a bioprosthetic valve can expect only slightly lower survival than those without aortic stenosis, and a low incidence of stroke and, up to 10 years, of structural valve deterioration. The rate of deterioration increases rapidly after 10 years, and particularly after 15 years.
Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St West, Hamilton, Ontario, Canada L8S 4L8 Heart Failure/Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada farid.foroutan@uhn.ca.
Farid
F
Foroutan
Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St West, Hamilton, Ontario, Canada L8S 4L8.
Gordon H
GH
Guyatt
Heart Failure/Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
Kathleen
K
O'Brien
Heart Failure/Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
Eva
E
Bain
Heart Failure/Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
Madeleine
M
Stein
Heart Failure/Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
Sai
S
Bhagra
Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St West, Hamilton, Ontario, Canada L8S 4L8.
Daegan
D
Sit
Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St West, Hamilton, Ontario, Canada L8S 4L8.
Rakhshan
R
Kamran
Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St West, Hamilton, Ontario, Canada L8S 4L8.
Yaping
Y
Chang
Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St West, Hamilton, Ontario, Canada L8S 4L8.
Tahira
T
Devji
Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St West, Hamilton, Ontario, Canada L8S 4L8.
Hassan
H
Mir
Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St West, Hamilton, Ontario, Canada L8S 4L8 Department of Internal Medicine, State University of New York at Buffalo, Buffalo, USA VA WNY Health Care System at Buffalo, Department of Veterans Affairs, USA.
Veena
V
Manja
Heart Failure/Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
Toni
T
Schofield
Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St West, Hamilton, Ontario, Canada L8S 4L8 Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Reed A
RA
Siemieniuk
Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St West, Hamilton, Ontario, Canada L8S 4L8 Division of General Internal Medicine, and Division of Clinical Epidemiology, University Hospitals of Geneva, Geneva, Switzerland.
Thomas
T
Agoritsas
Division of Cardiology, London Health Sciences Centre and Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada N6A 5W9.
Rodrigo
R
Bagur
Division of Cardiology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.
Catherine M
CM
Otto
Department of Internal Medicine, Innlandet Hospital Trust-division Gjøvik, Norway Institute of Health and Society, Faculty of Medicine, University of Oslo, Norway.
Per O
PO
Vandvik
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