Skip Navigation

This Article
Right arrow FREE Full Text (PDF) Freely available
Right arrow References
Right arrow E-letters: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Disclaimer
Right arrow Request Permissions
Google Scholar
Right arrow Articles by Takkenberg, J.J.M.
Right arrow Articles by Bogers, A.J.J.C.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Takkenberg, J.J.M.
Right arrow Articles by Bogers, A.J.J.C.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?


Prognosis after aortic valve replacement with St. Jude Medical bileaflet prostheses: impact on outcome of varying thromboembolic and bleeding hazards

J.J.M. Takkenberga,1, J.P.A. Puvimanasinghe1,2, L.A. van Herwerden1, E.W. Steyerberg2, M.J.C. Eijkemans2, J.D.F Habbema2 and A.J.J.C. Bogers1

a Department of Cardio-thoracic Surgery, Department of Public Health, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
b Center for Clinical Decision Sciences, Department of Public Health, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands

a Correspondence: Johanna J.M. Takkenberg, MD, Department of Cardio-thoracic Surgery, Bd162, Erasmus Medical Center Rotterdam, P.O. Box 2040, NL-3000CA, Rotterdam, The Netherlands.

Abstract

Aims Prognosis after aortic valve replacement (AVR) with mechanical prostheses depends on multiple inter-related factors. Investigation into these factors is complicated by limited knowledge on outcome after AVR and by the varying therapeutic ranges of International Normalized Ratio employed worldwide. Meta-analysis was combined with microsimulation to calculate evidence-based, age-specific outcomes after AVR with St. Jude Medical (SJM) prostheses (St. Jude Medical, Inc., St. Paul, MN, U.S.A.).

Method and results Eight studies were included in a meta-analysis of published results of primary isolated AVR with SJM prostheses (2986 patients, 16,163 patient-years) in order to estimate the hazard of postoperative valve-related events. Using microsimulation, calculated life expectancy and event-free life expectancy were 22 and 16 years in males aged 35 years, and 7 and 5 years in males aged 75 years, respectively. Calculated lifetime risks for thromboembolic and bleeding events were 22% and 15% in males aged 35 years, and 7% and 37% in males aged 75 years, respectively. Varying thromboembolic and bleeding hazards resulted in considerable shifts in lifetime risks and deaths associated with these events.

Conclusion Meta-analysis combined with microsimulation is a powerful tool with which to calculate reliable estimates of long-term prognosis, and allows detailed insight into the occurrence of valve-related events. Thromboembolism and bleeding occur frequently after AVR with mechanical prostheses and have an important impact on survival. Optimal control of International Normalized Ratio is therefore of utmost importance.

Key Words: Aortic valve replacement • bleeding • mechanical valves • prognostic modelling • thromboembolism


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 J. Thorac. Cardiovasc. Surg.Home page
M. W.A. van Geldorp, W.R. Eric Jamieson, A. P. Kappetein, J. Ye, G. J. Fradet, M. J.C. Eijkemans, G. L. Grunkemeier, A. J.J.C. Bogers, and J. J.M. Takkenberg
Patient outcome after aortic valve replacement with a mechanical or biological prosthesis: Weighing lifetime anticoagulant-related event risk against reoperation risk
J. Thorac. Cardiovasc. Surg., April 1, 2009; 137(4): 881 - 886.
[Abstract] [Full Text] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
J.J.M. Takkenberg, L.A. van Herwerden, M.J.C. Eijkemans, J.A. Bekkers, and A.J.J.C. Bogers
Evolution of allograft aortic valve replacement over 13 years: results of 275 procedures
Eur. J. Cardiothorac. Surg., April 1, 2002; 21(4): 683 - 691.
[Abstract] [Full Text] [PDF]


Disclaimer: Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.