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• W4206941914 abstract "We read the comments by Deutsch and colleagues1Deutsch C. Bramlage K. Bramlage P. Mitral valve replacement: time for a patient-level meta-analysis?.Ann Thorac Surg. 2022; 114: 350Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar regarding our manuscript.2Malvindi P.G. Mastro F. Kowalewski M. et al.Durability of mitral valve bioprostheses: a meta-analysis of long-term follow-up studies.Ann Thorac Surg. 2020; 109: 603-611Abstract Full Text Full Text PDF PubMed Scopus (24) Google Scholar As we have already reported and discussed in our paper, comparison of outcomes of different devices from different experiences and periods can be affected by several limitations. Regarding the durability of biological prostheses and our analysis:•Age represents one of the main determinants of structural valve deterioration, and differences in populations’ ages translate in a different a priori risk of prosthesis failure. The analysis restricted to populations operated on after 1980 allowed us to present data from cohorts of similar mean age.•A largely inhomogeneous definition of valve failure/structural valve deterioration was found among the included papers. We investigated and clearly acknowledged this aspect.•The use of clinical endpoints instead of imaging findings can underestimate the prevalence of prosthesis structural changes, although of nonclinical relevance. A long-term imaging follow-up was not available for porcine valves and this was highlighted and reported in a separate graph;•Alongside the choice of the most appropriate endpoint, follow-up time is crucial due to the nonlinear incidence of structural valve deterioration. We have provided all the details of the retrieved data in the main text, tables, and in the supplemental materials.•Owing to the difference in follow-up times of the included studies, we attempted to reconstruct the Kaplan-Meier curves using Engauge Digitizer 9.5 software as time-to-event data of individual studies using Cox regression and the algorithm specified by Guyot and colleagues3Guyot P. Ades A.E. Ouwens M.J. Welton N.J. Enhanced secondary analysis of survival data: reconstructing the data from published Kaplan-Meier survival curves.BMC Med Res Methodol. 2012; 12: 9Crossref PubMed Scopus (1141) Google Scholar up to the longest available follow-up across all trials in case the crude respective hazard ratios were not available from original studies. The accuracy of the method depends largely on the quality of input data and level of information provided by the publication containing patients’ numbers at risk at all time thresholds for all included studies. Whenever not available, these were approximated by the algorithm; however, always within the borders of the time frames imposed. To the extent that original published Kaplan-Meier curves tend to pool data over different covariates that might affect survival, the method is still not to be confused with the true individual patient data meta-analysis, and our findings should be viewed as exploratory. Nevertheless, the absolute event rates with 95% confidence intervals were derived from an analysis with adjusted models by person-years, a measure incorporating trial duration and absolute number of events, and are perfectly reflecting the trends seen in Kaplan-Meier curves. Other variables, usually not available or not reported, can have an impact on valve durability, clinical course, and manifestation of the prosthesis dysfunction. Annulus size and left ventricle geometry can favor the choice of a particular prosthesis, with pericardial valves maybe used more often in small and calcified annulus. Symptoms onset during the follow-up may be more striking for mitral regurgitation in porcine valves. Conversely, initially subtle stenosis of pericardial prostheses could require an earlier reintervention. Indeed, answering about durability of mitral prostheses presents many pitfalls and difficulties. Within these limitations and using a critical approach in retrieving data coming from different decades, we have provided a reference of biological mitral prostheses durability, which has been confirmed by subsequent papers reporting similar long-term results in middle-aged patients.4Bourguignon T. Espitalier F. Pantaleon C. et al.Bioprosthetic mitral valve replacement in patients aged 65 years or younger: long-term outcomes with the Carpentier-Edwards Perimount pericardial valve.Eur J Cardiothorac Surg. 2018; 54: 302-309Crossref PubMed Scopus (29) Google Scholar A direct comparison between new-generation porcine and pericardial valves is now available as recently published in The Annals.5Beute T.J. Goehler M. Parker J. et al.Long-term outcomes of Mosaic versus Perimount mitral replacements: 17-year follow-up of 940 implants.Ann Thorac Surg. 2020; 110: 508-515Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar This study, based on propensity-matched cohorts with a mean age of 68 years, reported acceptable long-term results for both prostheses, but, nevertheless, a significantly lower probability of reoperation for structural valve failure in patients who received a porcine valve. Mitral Valve Replacement: Time for a Patient-Level Meta-Analysis?The Annals of Thoracic SurgeryVol. 114Issue 1PreviewWe have read with interest the meta-analysis on the durability of mitral valve bioprostheses.1 The key finding was that the Medtronic Mosaic valve showed the lowest structural valve deterioration (SVD) and the longest survival compared with bovine or porcine Edwards valves. Full-Text PDF" @default.
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• W4206941914 date "2022-07-01" @default.
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• W4206941914 title "Limitations. Reprise." @default.
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• W4206941914 doi "https://doi.org/10.1016/j.athoracsur.2021.07.063" @default.
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