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Article Dans Une Revue The Journal of Thoracic and Cardiovascular Surgery Année : 2019

Structural Valve Deterioration of Bioprosthetic Aortic Valves: An Underestimated Complication

Résumé

OBJECTIVES: Structural 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. METHODS: Five 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. RESULTS: The 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. CONCLUSIONS: Appropriate statistical models should be used to avoid underestimating the SVD complication associated with worse long-term survival.
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hal-03158822 , version 1 (22-10-2021)

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Thomas Sénage, Florence Gillaizeau, Thierry Le Tourneau, Basile Marie, Jean-Christian Roussel, et al.. Structural Valve Deterioration of Bioprosthetic Aortic Valves: An Underestimated Complication. The Journal of Thoracic and Cardiovascular Surgery, 2019, 157 (4), pp.1383-1390.e5. ⟨10.1016/j.jtcvs.2018.08.086⟩. ⟨hal-03158822⟩
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