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Journal of Cardiothoracic Surgery
Published in: Journal of Cardiothoracic Surgery 1/2008

Open Access 01-12-2008 | Research article

Does preservation of the sub-valvular apparatus during mitral valve replacement affect long-term survival and quality of life? A Microsimulation Study

Authors: Christopher Rao, Jonathan Hart, Andre Chow, Fotios Siannis, Polyxeni Tsalafouta, Bari Murtuza, Ara Darzi, Frank C Wells, Thanos Athanasiou

Published in: Journal of Cardiothoracic Surgery | Issue 1/2008

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Abstract

Background

Techniques to preserve the sub-valvular apparatus in order to reduce morbidity and mortality following mitral valve replacement have been frequently reported. However, it is uncertain what impact sub-valvular apparatus preservation techniques have on long-term outcomes following mitral valve replacement. This study investigated the effect of sub-valvular apparatus preservation on long-term survival and quality of life following mitral valve replacement.

Methods

A microsimulation model was used to compare long-term survival and quality-adjusted life years following mitral valve replacement after conventional valve replacement and sub-valvular apparatus preservation. Probabilistic sensitivity analysis and alternative analysis were performed to investigate uncertainty associated with the results.

Results

Our Analysis suggests that patients survive longer if the sub-valvular apparatus are preserved (65.7% SD 1.5%, compared with 58.1% SD 1.6% at 10 years). The quality adjusted life years gained over a 10 year period where also greater after sub-valvular apparatus preservation. (6.54 QALY SD 0.07 QALY, compared with 5.61 QALY, SD 0.07 QALY). The superiority of preservation techniques was insensitive to patient age, parameter or model uncertainty.

Conclusion

This study suggests that long-term outcomes may be improved when the sub-valvular apparatus are preserved. Given the lack of empirical data further research is needed to investigate health-related quality of life after mitral valve replacement, and to establish whether outcomes differ between preservation techniques.
Appendix
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Metadata
Title
Does preservation of the sub-valvular apparatus during mitral valve replacement affect long-term survival and quality of life? A Microsimulation Study
Authors
Christopher Rao
Jonathan Hart
Andre Chow
Fotios Siannis
Polyxeni Tsalafouta
Bari Murtuza
Ara Darzi
Frank C Wells
Thanos Athanasiou
Publication date
01-12-2008
Publisher
BioMed Central
Published in
Journal of Cardiothoracic Surgery / Issue 1/2008
Electronic ISSN: 1749-8090
DOI
https://doi.org/10.1186/1749-8090-3-17

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