Does Aortic Valve Replacement Restore Normal Life Expectancy: a Twenty-Year Relative Survival Study

Abstract

<strong>Background </strong>This 20-year relative survival study investigates life expectancy in defined age cohorts<strong> </strong>and evaluates the role of patient, procedural and peri-operative variables on absolute survival after aortic valve replacement.<p> </p><p><strong>Methods </strong>Absolute long-term survival variance was calculated using Cox regression analysis in 585 consecutive aortic valve replacement patients. Relative survival curves in defined age groups were constructed using age- and gender-matched controls.</p><p><strong>Results</strong> There were 12 peri-operative deaths (2.1%), and 11 further deaths (1.9%) during the first year. 154 patients (26.3%) died subsequently and 408 patients (69.7%) were alive after 20 years. Relative survival increased with age: in patients over 68 survival was equivalent to an age- and gender-matched population. Patient risk indicators for decreased absolute survival included age, Parsonnet score, additive and logistic EuroSCORE, and for increased absolute survival included weight, body surface area, and stroke volume. Procedural risk indicators for decreased absolute survival included bypass time, use of a tissue valve, and prosthesis-patient mismatch with size 19 valves, and for an increased absolute survival included use of a mechanical valve. Post-operative risk indicators for decreased absolute survival included ITU stay, ventilation time, transfusion, haemorrhage volume and new-onset atrial fibrillation/flutter. Strong risk indicators included intra-aortic balloon pump use, and dialysis.</p><p> </p><p><strong>Conclusions</strong> Patients over 68 years discharged from hospital after aortic valve replacement had a similar 10-year survival as an age- and gender-matched population. In this age cohort surgery restored the patient’s normal life expectancy.</p><p> </p><p>Key words: aortic valve replacement; absolute survival predictors; relative survival</p>

Long-Term Survival Following Aortic Valve Replacement: the Influence of Age, Prosthesis-Patient Mismatch and Indexed Effective Orifice Area

“…Certain complications have been shown, by multivariate analysis, to affect long-term outcome. [29] In this study risk stratification was higher by logistic (p=0.046) and additive EuroSCORE (p=0.037) in patients without PPM because this group was older by 2.52 years, age being a contributor to the score. The incidence of mismatch is higher in younger patients and this may attenuate its effect on survival.…”

“…Although mismatch leads to adverse cardiac events its effect on survival is reduced by advancing age. [29] Our results suggest that age, and its direct effect on follow-up duration, significantly affects survival whereas mismatch does not.…”

Long-term Survival after Aortic Valve Replacement with the Mitroflow Bioprosthesis: a Comparative Study

“…[17] Age and comorbidities at the time of surgery significantly affect longterm survival. [16,18,19] Although up to 30% of patients are known to exhibit subclinical valve degeneration on echo, with an increase of >10mm Hg in mean trans-valvular gradient, clinically relevant SVD is infrequent. Less than half of the latter patients undergo a further procedure because of limiting comorbid conditions.…”