Actuarial versus actual risk of porcine structural valve deterioration

G. L. Grunkemeier, W. R.E. Jamieson, D. C. Miller, A. Starr

Research output: Contribution to journalArticlepeer-review

137 Scopus citations

Abstract

Actuarial analysis, using nonparametric (e.g., life table or Kaplan- Meier) or parametric (statistical modeling) methods, is used to describe and compare survival probabilities by allowing for partial survival times (censoring). Although devised to describe freedom from death, this method has been extended to nonfatal complications, such as freedom from tissue valve failure. However, the risk described for nonfatal events is that which a patient would experience provided he were immortal. And patients with valve disease have a relatively high risk of dying, generating the question: 'What is the chance the valve will fail before the patient dies?' To answer this more practical (for individual patient management and population resource allocation) question requires an estimate of what we call actual failure, that is, the percentage of patients whose valve will actually fail before they die. This risk is less than the risk which the usual actuarial curve describes. This difference increases with patient age, because older patients have a lower risk of tissue failure and a higher risk of death than younger patients.

Original languageEnglish (US)
Pages (from-to)709-718
Number of pages10
JournalJournal of Thoracic and Cardiovascular Surgery
Volume108
Issue number4
DOIs
StatePublished - 1994

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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