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Eur J Cardiothorac Surg 2006;29:374-379
© 2006 Elsevier Science NL

Comparison of Carpentier-Edwards pericardial and supraannular bioprostheses in aortic valve replacement

^a Department of Cardio-thoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
^b Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
^c University of British Columbia, Vancouver, Canada
^d Providence Health System, Portland, OR, USA

Received 21 March 2005; received in revised form 14 October 2005; accepted 28 November 2005.

^_* Corresponding author. Tel.: +31 10 463 5413; fax: +31 10 463 3993. (Email: j.j.m.takkenberg{at}erasmusmc.nl).

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 (2685 patients, 12,250 patient-years) and five studies on the supraannular valves (3796 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.

Key Words: Aortic valve replacement • Bioprostheses • Prognostic modeling

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