• Thomas Sénage, Florence Gillaizeau, Thierry Le Tourneau, Basile Marie, Jean-Christian Roussel, and Yohann Foucher.
• INSERM UMR 1246 - SPHERE for Nantes University, Tours University, Tours, France; Cardiothoracic Surgical Unit, Thorax Institute, St Herblain, France. Electronic address: thomas.senage@chu-nantes.fr.
• J. Thorac. Cardiovasc. Surg. 2019 Apr 1; 157 (4): 1383-1390.e5.

ObjectivesStructural valve deterioration (SVD) remains a major bioprosthesis-related complication, as recently described for the Mitroflow valve (models LX and 12A) (LivaNova, London, United Kingdom). The real incidence of the SVD risk remains unclear, often due to methodologic pitfalls by systematically using the Kaplan-Meier estimator and/or the Cox model. In this report, we propose for the first time a precise statistical modeling of this issue.MethodsFive hundred sixty-one patients who underwent aortic valve replacement with the aortic Mitroflow valve between 2002 and 2007 were included. We used an illness-death model for interval-censored data. Median follow-up was 6.6 years; 103 cases of SVD were diagnosed.ResultsThe 4-year and 7-year SVD cumulative incidences after the first anniversary of surgery were 15.2% (95% confidence interval, 11.9-19.1) and 31.0% (95% confidence interval, 25.8-37.2), respectively. Female gender, dyslipidemia, chronic obstructive pulmonary disease, and severe patient-prosthesis mismatch were significant risk factors of SVD. The occurrence of SVD was associated with a 2-fold increase in the risk of death.ConclusionsAppropriate statistical models should be used to avoid underestimating the SVD complication associated with worse long-term survival.Copyright © 2018 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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