Actuarial versus actual risk of porcine structural valve deterioration

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Presentation transcript:

Actuarial versus actual risk of porcine structural valve deterioration Gary L. Grunkemeier, PhDa, W.R. Eric Jamieson, MDb, D.Craig Miller, MDc, Albert Starr, MDa The Journal of Thoracic and Cardiovascular Surgery Volume 108, Issue 4, Pages 709-718 (October 1994) DOI: 10.5555/uri:pii:S0022522394702985 Copyright © 1994 Mosby, Inc. Terms and Conditions

Fig. 1 Actuarial freedom from SVD for two porcine heart valve series and the corresponding cumulative incidence of (actual) SVD. The Vancouver series is entirely Carpentier-Edwards valves, and the Stanford series is predominantly Hancock valves. The nonparametric (Kaplan-Meier) SVD-free curves are remarkably similar for these two series of isolated valve replacements performed from 1975 to 1988. The actual incidence curves describe a lower percentage of SVD than the actuarial curves would imply. The Journal of Thoracic and Cardiovascular Surgery 1994 108, 709-718DOI: (10.5555/uri:pii:S0022522394702985) Copyright © 1994 Mosby, Inc. Terms and Conditions

Fig. 2 Actuarial freedom from SVD by age group for isolated valve replacement; nonparametric Kaplan-Meier curves (jagged lines) and Weibull model (smooth curves). The Journal of Thoracic and Cardiovascular Surgery 1994 108, 709-718DOI: (10.5555/uri:pii:S0022522394702985) Copyright © 1994 Mosby, Inc. Terms and Conditions

Fig. 3 Actuarial freedom from SVD by valve position for isolated valve replacement; nonparametric Kaplan-Meier curves (jagged lines) and Weibull model (smooth curves). The Journal of Thoracic and Cardiovascular Surgery 1994 108, 709-718DOI: (10.5555/uri:pii:S0022522394702985) Copyright © 1994 Mosby, Inc. Terms and Conditions

Fig. 4 Actuarial freedom from SVD for double valve replacement; nonparametric Kaplan-Meier curves (jagged lines) and Weibull model (smooth curves). The Weibull model used separate regression equations for the potential SVD risk of each valve, assuming an additive risk of SVD for the two valves. The Journal of Thoracic and Cardiovascular Surgery 1994 108, 709-718DOI: (10.5555/uri:pii:S0022522394702985) Copyright © 1994 Mosby, Inc. Terms and Conditions

Fig. 5 Patient survival by age group, excluding SVD-related deaths, for isolated valve replacement. Actuarial curves (jagged lines) and Gompertz model (smooth curves) based on a previously developed model (see text). The Journal of Thoracic and Cardiovascular Surgery 1994 108, 709-718DOI: (10.5555/uri:pii:S0022522394702985) Copyright © 1994 Mosby, Inc. Terms and Conditions

Fig. 6 Cumulative incidence of SVD by age group, for isolated valve replacement. Nonparametric curves (jagged lines) and parametric model (smooth curves). The Journal of Thoracic and Cardiovascular Surgery 1994 108, 709-718DOI: (10.5555/uri:pii:S0022522394702985) Copyright © 1994 Mosby, Inc. Terms and Conditions

Fig. 7 Example of cumulative incidence of SVD, based on the parametric model, for a female patient having mitral valve replacement according to herage at implantation. The probability that the valve will ever need replacement (i.e., fail before the patient dies) is indicated by the solid symbols at the ends of the curves. The Journal of Thoracic and Cardiovascular Surgery 1994 108, 709-718DOI: (10.5555/uri:pii:S0022522394702985) Copyright © 1994 Mosby, Inc. Terms and Conditions

Fig. 8 Nomogram for the probability of ever experiencing re-replacement for SVD according to age at implantation, gender, and valve position. These probabilities are strongly related to age at implantation, and less affected by valve position and patient gender. The various ages for the female patient with mitral replacement in Fig. 7 are indicated by the solid symbols. The Journal of Thoracic and Cardiovascular Surgery 1994 108, 709-718DOI: (10.5555/uri:pii:S0022522394702985) Copyright © 1994 Mosby, Inc. Terms and Conditions