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Age and valve size effect on the long-term durability of the Carpentier-Edwards aortic pericardial bioprosthesis  Michael K Banbury, MD, Delos M Cosgrove,

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Presentation on theme: "Age and valve size effect on the long-term durability of the Carpentier-Edwards aortic pericardial bioprosthesis  Michael K Banbury, MD, Delos M Cosgrove,"— Presentation transcript:

1 Age and valve size effect on the long-term durability of the Carpentier-Edwards aortic pericardial bioprosthesis  Michael K Banbury, MD, Delos M Cosgrove, MD, Jennifer A White, MS, Eugene H Blackstone, MD, Robert W M. Frater, MD, J.Edward Okies, MD  The Annals of Thoracic Surgery  Volume 72, Issue 3, Pages (September 2001) DOI: /S (01)

2 Fig 1 Explant for structural valve dysfunction (SVD) and the competing risk of death before explant. (A) Freedom from SVD. Each square represents an event positioned by the method of Kaplan and Meier. Vertical bars are asymmetric 68% confidence limits. The number in parentheses is the number of patients still traced beyond the various points given. The solid line is the parametric estimate of freedom from SVD, and is enclosed within dashed 68% confidence limits. (B) Survival without explantation. The format is as in (A). (C) Rates of SVD and death (hazard functions). These hazard functions are used to generate the competing risks estimates. (D) Competing risks estimates. The proportion of patients alive without explant (event-free survival), death before explant, and explant for SVD are depicted across time. Each patient can only be in one of these categories at any given moment in time, so they add to 100%. The depiction is similar to that of (A) and (B). (E) “Actuarial” versus “actual” structural valve dysfunction estimates. The depiction contrasts the so-called actuarial estimate of SVD, an estimate that relates directly to the rate at which the valve experiences sufficient dysfunction to warrant explant, as opposed to the “actual” estimate of the proportion of patients likely to survive sufficiently long to experience SVD. The Annals of Thoracic Surgery  , DOI: ( /S (01) )

3 Fig 2 Impact of age on survival and structural valve dysfunction (SVD). Each of the depictions is similar to that of Figure 1A and 1B, except that the patients have been stratified into broad age groups. Twenty-seven patients were younger than 50 years (•), 150 patients were between 50 and 70 years (○), and 90 patients were 70 years and older (□). •, ○, and □ represent Kaplan–Meier estimates. (A) Explant for SVD. (B) Survival before prosthesis explant for any reason. The Annals of Thoracic Surgery  , DOI: ( /S (01) )

4 Fig 3 Depiction of the age-related structural valve dysfunction (SVD) in the pericardial valve. (A) Freedom from SVD for a patient whose valve was implanted at ages 45, 55, 65, and 75. (B) Fifteen-year freedom from SVD across the entire spectrum of age. The Annals of Thoracic Surgery  , DOI: ( /S (01) )

5 Fig 4 Risk-adjusted estimates of explant for structural valve dysfunction (SVD) by competing risk analysis. For this figure, the patient was assumed to be a man in New York Heart functional class III, undergoing first valve replacement, and not undergoing concomitant coronary artery bypass or ascending aorta replacement. The depictions are so-called nomograms of the two risk-factor analyses, one for explant for SVD and the other for death before explant. (A) Evolution of SVD across time for a patient aged 45, 55, 65, and 75 years at implant. (B) Fifteen-year freedom from requirement for explantation for SVD in a similar patient, but across the continuous spectrum of ages. The Annals of Thoracic Surgery  , DOI: ( /S (01) )


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