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Ann Thorac Surg 2001;71:S344-S348
© 2001 The Society of Thoracic Surgeons

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Autografts, allografts, and biological valves in children

Estimated event-free life expectancy after autograft aortic root replacement in adults

^a Department of Cardiothoracic Surgery, and the Center for Clinical Decision Sciences, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
^b Department of Public Health, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands

Address reprint requests to Dr Takkenberg, Department of Cardiothoracic Surgery, Erasmus Medical Center Rotterdam, Bd162, PO Box 2040, 3000CA Rotterdam, The Netherlands
e-mail: takkenberg{at}thch.azr.nl

Presented at the VIII International Symposium on Cardiac Bioprostheses, Cancun, Mexico, Nov 3–5, 2000.

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.

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				A. J. J. C. Bogers, A.-P. Kappetein, J. W. Roos-Hesselink, and J. J.M. Takkenberg Is a bicuspid aortic valve a risk factor for adverse outcome after an autograft procedure? Ann. Thorac. Surg., June 1, 2004; 77(6): 1998 - 2003. [Abstract] [Full Text] [PDF]

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