Life expectancy and determinants of relative survival following surgical aortic valve replacement for aortic stenosis

Surgical aortic valve replacement (SAVR) improves survival in severe, symptomatic aortic stenosis (AS), but whether it fully restores life expectancy is uncertain. This study aimed to evaluate long-term relative survival following SAVR compared with the general population and identify predictors of any residual survival discrepancies.

A total of 1287 patients (median age 71 (63-77) years, 32% female) undergoing SAVR for ≥moderate AS were identified from the Western Australian Heart Valves Study database. Flexible parametric models were used to estimate relative survival.

Over a median follow-up of 47 (23-81) months, 247 (19%) patients died. All-cause 30-day, 1-year, 5-year and 10-year relative survivals were 97.3%, 97.2%, 93.0% and 83.3%, respectively, compared with an age-matched, sex-matched and year-matched general population. Flexible multivariable modelling indicated impaired left ventricular ejection fraction (LVEF) (45%-60%, excess HR 1.97, 95% CI 1.11 to 3.51, p=0.02; 30%-45%, excess HR 2.40, 95% CI 1.24 to 4.64, p=0.01; <30%, excess HR 2.96, 95% CI 1.18 to 7.39, p=0.02), significant mitral regurgitation (MR) (excess HR 2.28, 95% CI 1.29 to 4.03, p=0.005), Indigenous status (excess HR 4.53, 95% CI 2.03 to 10.12, p<0.001), diabetes mellitus (excess HR 2.30, 95% CI 1.44 to 3.68, p<0.001), estimated glomerular filtration rate (eGFR) 30-59 mL/kg/1.73 m² (excess HR 2.74, 95% CI 1.33 to 5.65, p=0.006) and eGFR 0-29 mL/kg/1.73 m² (excess HR 5.75, 95% CI 2.36 to 13.99, p<0.001) were independently associated with long-term excess mortality relative to that of the national comparator, whereas age, sex, year of surgery, concomitant coronary artery bypass graft surgery and symptom status were not.

In a contemporary population, relative survival following SAVR for significant AS was reduced compared with an age-matched, sex-matched and year-matched general population. Impaired LVEF, significant MR, Indigenous status, renal impairment and diabetes mellitus were independent predictors of long-term excess mortality. Timely intervention and optimised postoperative follow-up may be crucial for the restoration of normal life expectancy following SAVR.