Abstract 17030: Choice of Initial and Sequential Aortic Valve Prosthesis at Age 18: What Are the Implications Over a Lifetime?
Introduction: Current AHA/ACC guidelines recommend that patients under 65 years of age who undergo aortic valve replacement receive a mechanical valve. However, due to complexity and cost, the lifelong implication of valve choice in young patients has not been explored. The purpose of this investigation is to determine the type and sequence of valve replacements for a young person that maximizes overall longevity free of permanent stroke, intracranial hemorrhage and death.
Methods: We used a Markov decision model to simulate a cohort of 30,000 patients undergoing first aortic valve replacement at 18 years of age. We compared: Strategy 1: bioprosthetic valve followed by subsequent bioprosthetic valve replacements; Strategy 2: bioprosthetic valve followed by guideline recommended valve replacements (mechanical valve for patients <65 years and bioprosthetic for patients ≥65 years); Strategy 3: mechanical valve followed by guideline recommended valve replacements. The combined endpoint was years free of permanent stroke, intracranial hemorrhage or death. Data from large cohorts was used to estimate yearly probabilities. Sensitivity analysis was used to assess uncertainty of the probabilities included.
Results: For the combined endpoint, Strategy 1 had the longest mean freedom from events (35 years) followed by Strategy 2 (33.3 years) and Strategy 3 (31.9 years). Sensitivity analysis showed that Strategy 1 had the longest freedom from events unless post-operative death for valve replacement was greater than 20%, probability for intracranial bleed was 1% per year for those <65 years with a bioprosthetic valve.
Conclusion: This simulation suggests that selection of bioprosthetic valve in young adults is a reasonable choice with similar long-term outcomes compared to a mechanical valve despite the higher number of reoperations.
- © 2013 by American Heart Association, Inc.