Comparative method for actuarial analysis of cardiac valve replacements.

Abstract

The use of survival analysis in cardiac surgical reports has been widely accepted in order to characterise and compare performances of different valve prostheses. However, the analyses that have been described elsewhere may be improved in several respects. The original method proposed for prosthetic valve evalation examined follow-up related to patients rather than the valves themselves and therefore neglected the possibility of factors other than the valve itself which could affect the fate of cardiac patients. Furthermore, there has not yet been any application of life table methods to compare two different sets of data, or to estimate the average time before an event occurs. The present work defines valve function and malfunction and separates patient survival from valve performance. We define statistical indices, namely the median remaining lifetime and the instantaneous decrement rate. Both indices can be useful; the former measures the average survival time and the latter focuses attention on the intensity of risk changes. Using established statistical theory we calculate the significance level of difference between two independent survival rates. We qualify the presentation of probabilities with a statement of the associated standard errors.