• Simone A Huygens, Etnel Jonathan R G JRG Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands., Milad Hanif, Jos A Bekkers, Bogers Ad J J C AJJC Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands., Rutten-van Mölken Maureen P M H MPMH Institute for Medical Technology Assessment, Rotterdam/Erasmus School of Health Policy and Management, Erasmus University, Rotterdam,, and Takkenberg Johanna J M JJM Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands. Electronic address: j.j.m.takkenberg@erasm.
• Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands; Institute for Medical Technology Assessment, Rotterdam/Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands.
• J. Thorac. Cardiovasc. Surg. 2019 Jun 1; 157 (6): 2189-2197.e14.

ObjectiveTo support decision-making in aortic valve replacement (AVR) in elderly patients, we provide a comprehensive overview of outcome after AVR with bioprostheses.MethodsA systematic review was conducted of studies reporting clinical outcome after AVR with bioprostheses in elderly patients (mean age ≥70 years; minimum age ≥65 years) published between January 1, 2000, to September 1, 2016. Reported event rates and time-to-event data were pooled and entered into a microsimulation model to calculate life expectancy and lifetime event risks.ResultsForty-two studies reporting on 34 patient cohorts were included, encompassing a total of 12,842 patients with 55,437 patient-years of follow-up (pooled mean follow-up 5.0 ± 3.3 years). Pooled mean age was 76.5 ± 5.5 years. Pooled early mortality risk was 5.42% (95% confidence interval [CI], 4.49-6.55), thromboembolism rate was 1.83%/year (95% CI, 1.28-3.61), and bleeding rate was 0.75%/year (95% CI, 0.50-1.11). Structural valve deterioration (SVD) was based on pooled time to SVD data (Gompertz; shape: 0.124, rate: 0.003). For a 75-year-old patient, this translated to an estimated life expectancy of 9.8 years (general population: 10.2 years) and lifetime risks of bleeding of 7%, thromboembolism of 17%, and reintervention of 9%.ConclusionsThe low risks of SVD and reintervention support the use of bioprostheses in elderly patients in need of AVR. The estimated life expectancy after AVR was comparable with the general population. The results of this study inform patients and clinicians about the expected outcomes after bioprosthetic AVR and thereby support treatment decision-making. Furthermore, our results can be used as a benchmark for long-term outcomes after transcatheter aortic valve implantation in patients who were eligible for surgery and other (future) alternative treatments (eg, tissue-engineered heart valves).Copyright © 2018 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

13 keywords...

hide…