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Review

Cardiac crossroads: deciding between mechanical or bioprosthetic heart valve replacement

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Pages 91-99 | Published online: 17 Feb 2011

Figures & data

Figure 1 Photographs of commonly used prosthetic valves. Left: single-tilting-disk (Medtronic-Hall, Medtronic, Minneapolis, MN) valve; Right: bileaflet-tilting-disk (St Jude Medical, Little Canada, MN) valve.

Notes: Copyright © 1996. Massachusetts Medical Society. Reprinted with permission from Vongpatanasin W, Hillis LD, Lange RA. Medical progress: prosthetic heart valves. N Engl J Med. 1996;335:407–416.Citation4
Figure 1 Photographs of commonly used prosthetic valves. Left: single-tilting-disk (Medtronic-Hall, Medtronic, Minneapolis, MN) valve; Right: bileaflet-tilting-disk (St Jude Medical, Little Canada, MN) valve.

Figure 2 Two-way sensitivity analysis of the effects of anticoagulant-related bleeding and patient age at implantation on the recommended valve type.

Notes: RR = relative risk where RR = 1 is the baseline estimate, RR = 1.5 is 50% higher than the baseline estimate, and RR = 0.5 is 50% lower than the baseline estimate. Copyright © 2000. Elsevier. Reprinted with permission from Birkmeyer NJ, Birkmeyer JD, Tosteson AN, et al. Prosthetic valve type for patients undergoing aortic valve replacement: a decision analysis. Ann Thorac Surg. 2000;70:1946–1952.Citation26
Figure 2 Two-way sensitivity analysis of the effects of anticoagulant-related bleeding and patient age at implantation on the recommended valve type.

Figure 3 Photograph of Porcine (Carpentier–Edwards) Bioprosthesis.

Notes: Copyright © 1996. Massachusetts Medical Society. Reprinted with permission from Vongpatanasin W, Hillis LD, Lange RA. Medical progress: prosthetic heart valves. N Engl J Med. 1996;335:407–416.Citation4
Figure 3 Photograph of Porcine (Carpentier–Edwards) Bioprosthesis.

Figure 4 Two-way sensitivity analysis of the effects of reoperation for tissue valve failure and patient age at implantation on the recommended valve type.

Notes: RR = relative risk where RR = 1 is the baseline estimate, RR = 1.5 is 50% higher than the baseline estimate, and RR = 0.5 is 50% lower than the baseline estimate. Copyright © 2000. Elsevier. Reprinted with permission from Birkmeyer NJ, Birkmeyer JD, Tosteson AN, et al. Prosthetic valve type for patients undergoing aortic valve replacement: a decision analysis. Ann Thorac Surg. 2000;70:1946–1952.Citation26
Figure 4 Two-way sensitivity analysis of the effects of reoperation for tissue valve failure and patient age at implantation on the recommended valve type.

Figure 5 Two-way sensitivity analysis of the effects of mortality with reoperation and patient age at implantation on the recommended valve type.

Notes: RR = relative risk where RR = 1 is the baseline estimate, RR = 1.5 is 50% higher than the baseline estimate, and RR = 0.5 is 50% lower than the baseline estimate. Copyright © 2000. Elsevier, Reprinted with permission from Birkmeyer NJ, Birkmeyer JD, Tosteson AN, et al. Prosthetic valve type for patients undergoing aortic valve replacement: a decision analysis. Ann Thorac Surg. 2000;70:1946–1952.Citation26
Figure 5 Two-way sensitivity analysis of the effects of mortality with reoperation and patient age at implantation on the recommended valve type.

Figure 6 Algorithm for choice of prosthetic heart valve.

Notes: Copyright © 2010. Elsevier. Reprinted with permission from Rahimtoola SH. Choice of prosthetic heart valve in adults: an update. J Am Coll Cardiol. 2010;55: 2413–2426.Citation15
Abbreviations: A/C, anticoagulants; AVR, aortic valve replacements; INR, international normalized ratio; MVR, mitral valve replacements.
Figure 6 Algorithm for choice of prosthetic heart valve.

Figure 7 Schematic of decision model structure. All patients are initially in the event-free state. With each 1-year cycle of the model, they can move to a different state or remain in the same state according to chance events specified under “Chance events each cycle”.

Notes: Event-free: alive without reoperation or major bleeding; Alive following reoperation: alive following reoperation for prosthetic valve failure; Alive following bleeding: alive following a major (requiring hospitalization or blood transfusion) bleeding event; Dead: dead from any cause. Copyright © 2000. Elsevier. Reprinted with permission from Birkmeyer NJ, Birkmeyer JD, Tosteson AN, et al. Prosthetic valve type for patients undergoing aortic valve replacement: a decision analysis. Ann Thorac Surg. 2000;70:1946–1952.Citation26
Figure 7 Schematic of decision model structure. All patients are initially in the event-free state. With each 1-year cycle of the model, they can move to a different state or remain in the same state according to chance events specified under “Chance events each cycle”.