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Eur J Cardiothorac Surg 2006;30:954
© 2006 Elsevier Science NL

Letters to the Editor

Reply to Wu and Grunkemeier

^a Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ont., Canada
^b Department of Epidemiology, University of Ottawa, Ottawa, Ont., Canada

Received 11 September 2006; accepted 15 September 2006.

^_* Corresponding author. Address: University of Ottawa Heart Institute, 40 Ruskin Street, Suite 3403, Ottawa, Ont., Canada K1Y 4W7. Tel.: +1 613 761 4893; fax: +1 613 761 4713. (Email: mruel{at}ottawaheart.ca).

Key Words: Aortic valve replacement • Mitral valve replacement • Heart valve • Bioprosthesis • Mechanical • Outcomes (includes mortality • morbidity)

We thank Wu and Grunkemeier for their insightful comments [1] regarding our manuscript that compared mechanical and bioprosthetic valve replacement in middle-aged patients [2]. Cumulative incidence (actual) analysis is an important statistical technique for use in the analysis of events other than death after valve replacement, and we have employed this technique in our previous work [3]. Drs Wu and Grunkemeier are to be applauded for their pioneering work in this field [4].

In studying the outcomes after valve replacement in middle-aged patients, we performed both actuarial and cumulative incidence (actual) analysis. However, we chose to present only the actuarial analysis in the final manuscript for several reasons. Firstly, we are aware of the recent string of editorials and letters to the editor passionately debating the use of cumulative incidence (actual) analysis. Two other prominent cardiac surgery journals have issued a moratorium on the publication of ‘actual freedom’ results [5]. Secondly, as Drs Wu and Grunkemeier have pointed out, the difference between the results from actuarial and cumulative incidence (actual) analysis increases as the age of the cohort increases [4]. Thus, for a relatively young (middle-age) population with a low competing risk of death, we believe that employing only actuarial analysis is generally sufficient. Finally, but most importantly, both the actuarial and cumulative incidence (actual) techniques led to similar results and conclusions in this study. Therefore, for the purpose of simplicity, and in order to avoid the controversial debate, we reported only the actuarial analysis in the manuscript.

References

1. Wu Y, Grunkemeier GL. What is the risk that I will have a major complication after my valve operation?. Eur J Cardiothorac Surg 2006;30:953-954.[Free Full Text]
2. Kulik A, Bedard P, Lam BK, Rubens FD, Hendry PJ, Masters RG, Mesana TG, Ruel M. Mechanical versus bioprosthetic valve replacement in middle-aged patients. Eur J Cardiothorac Surg 2006;30:485-491.[Abstract/Free Full Text]
3. Ruel M, Kulik A, Rubens FD, Bedard P, Masters RG, Pipe AL, Mesana TG. Late incidence and determinants of reoperation in patients with prosthetic heart valves. Eur J Cardiothorac Surg 2004;25:364-370.[Abstract/Free Full Text]
4. Grunkemeier GL, Wu Y. Interpretation of nonfatal events after cardiac surgery: actual versus actuarial reporting. J Thorac Cardiovasc Surg 2001;122:216-219.[Abstract/Free Full Text]
5. Bodnar E, Blackstone EH. Editorial: An ‘actual’ problem: Another issue of apples and oranges. J Heart Valve Dis 2005;14:706-708.[Medline]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Alexander Kulik Marc Ruel Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Kulik, A. Articles by Ruel, M. Search for Related Content PubMed Articles by Kulik, A. Articles by Ruel, M. Related Collections Valve disease