Survival and cause of death after isolated primary aortic valve replacement at Oslo University Hospital (2012-2021): a retrospective registry-based study

The treatment of aortic valve disease has changed following the introduction of transcatheter aortic valve replacement (TAVR). Hence, the selection of patients for surgical aortic valve replacement (AVR) is changing. Thus, we aimed to study survival and causes of death following surgical AVR at a large Scandinavian Centre in the period 2012-21.

Information about the surgical procedure, survival and cause of death was obtained from the National Norwegian Health Registries. The latest clinical information about the deceased patients was made available from the local hospitals and examined to evaluate the causes of death from The Norwegian Cause of Death Registry.

From 2012 to 2021, the number of surgical implantations of aortic valve bioprostheses (AVR(b)) and patient age at the time of surgery decreased. Outcomes were excellent, with 30-day survival of 98.6% following AVR(b) and 99.8% following AVR(m). 1-year survival after AVR(b) improved from 96.4% in the first half to 98.4% in the second half of the study period, probably due to a reduction of operative risk during the study period. Non-cardiovascular mortality was the most frequent cause of death, followed by cancer, cardiovascular and valve-related death. Deaths due to cerebral bleeding or stroke were the least frequent with 10-year estimators of 1.3% and 1.6% following AVR(m) and AVR(b), respectively. The inter-rater reliability between The Norwegian Cause of Death Registry and the journal information provided was moderate, with an unweighted Cohen's kappa of 0.56 (0.47-0.64).

Valve-related death and death from cerebral bleeding or stroke was rare after surgical AVR. Survival was high and improved during the study period. Surgical AVR may be performed safely in low-risk patients.