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Published on: December 11, 2017
Long-term absolute and relative survival after aortic valve replacement: a prospective cohort study
Andrea Lassnigg1, Michael Hiesmayr, Sophie Frantal
1From the Department of Cardiothoracic and Vascular Anaesthesia and Intensive Care Medicine, University Hospital of Vienna (AL,MH,MM), Institute of Medical Statistics, Medical University of Vienna (SF,WB), Clinical Institute of Infection Control and Hospital Epidemiology, University Hospital of Vienna, Vienna, Austria (EP), Anesthésie Réanimation Chirurgie Cardio-thoracique et Vasculaire, CHU Pierre Zobda-Quitman Fort de France, Martinique, France (CI), Horten Centre, University Hospital Zürich, Zürich, Switzerland (LMB), Department of Cardiac Surgery, University Hospital of Vienna, Vienna (MA), Department of Cardiac Surgery, University Hospital of Salzburg, Salzburg, Austria (RS), Anaesthesia and Intensive Care Medicine, Hirslanden Klinik Im Park, Zürich, Switzerland (DS).
Background:
Aortic valve replacement is one of the most common cardiac surgical procedures, especially in elderly patients. Whether or not there is a net life gain over a long period of time is a matter for debate.
Objective:
To compare survival of patients with that of the age, sex, and follow-up year-matched normal population (relative survival).
Design:
Single-centre, prospectively collected data.
Setting:
Tertiary care centre, Vienna, Austria.
Patients:
We enrolled 1848 patients undergoing elective aortic valve replacement between 1997 and the end of 2008.
Interventions:
None.
Main Outcome Measurement:
Relative survival at the end of 2011 as determined by relative Cox regression analysis.
Results:
Sixty-nine patients (3.7%) died within the first 30 days. Another 70 patients (3.8%) died within the first year and 429 (23.2%) died during the remaining follow-up period. The longest follow-up period was 14 years (median, 5.8; interquartile range, 3.2 to 8.9). Medical risk indicators for relative survival were diabetes mellitus [hazard ratio 1.69, 95% confidence interval, CI 1.37 to 2.07, P<0.001], pulmonary disease (hazard ratio 1.45, 95% CI 1.16 to 1.81, P=0.001), history of atrial fibrillation (hazard ratio 1.35, 95% CI 1.10 to 1.66, P=.005) and angiotensin-converting enzyme inhibitor medication (hazard ratio 1.21, 95% CI 1.02 to 1.44, P=0.031). Perioperative risk indicators were urgent surgery (hazard ratio 1.40, 95% CI 1.00 to 1.94, P=0.047), resternotomy at 48 h or less (hazard ratio 1.87, 95% CI 1.29 to 2.70, P=0.001), resternotomy at more than 48 h (hazard ratio 1.80, 95% CI 1.32 to 2.45, P<0.001), blood transfusion (hazard ratio 1.06, 95% CI 1.01 to 1.12, P=0.018) and renal replacement therapy (hazard ratio 2.02, 95% CI 1.41 to 2.90, P<0.001). Relative survival was highest in the oldest age quartile (76 to 94 years) and lowest in the youngest (19 to 58 years) (hazard ratio 0.27, 95% CI 0.21 to 0.36; P<0.001).
Conclusion:
Patients who survived the first year after aortic valve replacement had a similar chance of survival as the matched normal population. Relative survival benefit was higher in the oldest age quartile.
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