Decision guidelines for prophylactic replacement of Bjork-Shiley convexo-concave heart valves impact on clinical practice

Article

关键词: OUTLET STRUT FRACTURE;    FOLLOW-UP;    MORTALITY;    RISK;    UK;   

DOI  :  10.1161/01.CIR.0000125853.51637.C8

来源: SCIE

【 摘 要 】

Background - Because of risk of outlet strut fracture, prophylactic replacement should be considered for Bjork-Shiley convexo-concave (BScc) valve recipients. We assessed the effects of epidemiological and decision-analytic guidelines on actual BScc valve replacement. Methods and Results - We performed a retrospective cohort study including all 2263 Dutch BScc patients with a mean follow-up of 11.3 years ( range, 0 to 23 years). Outcomes were outlet strut fracture, mortality, and BScc valve replacement. For the surviving patients in 1992 (n = 1330), we calculated the expected differences in life expectancy ( LE) with and without BScc valve replacement according to decision guidelines developed in 1992. Differences in LE were compared with actual replacements. During 8 years of follow-up, there were 494 deaths (40%), and 11 patients had suffered outlet strut fracture. Of 1330 patients, 96 (10%) had undergone BScc valve replacement, particularly in years after introduction of initial and updated guidelines. One hundred seventeen patients (9%) had an estimated gain in LE after BScc valve replacement. These patients were more likely to undergo replacement than patients with an estimated loss of LE ( hazard ratio, 6.6; 95% CI, 4.4 to 10; P <0.0001). A loss in LE after reoperation was predicted for 8 of 11 patients who experienced outlet strut fracture after guidelines were available. Conclusions - Valve replacement for BScc heart valve patients was largely in concordance with guidelines in the Netherlands. Individualized guidelines that are based on high-quality epidemiological data and are updated and implemented rigorously can influence clinical practice in complex decision problems.

【 授权许可】

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