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Published on: December 11, 2017
Long-term relative survival after primary heart valve replacement
E Ståhle1, P Kvidal, S O Nyström
1Department of Thoracic and Cardiovascular Surgery, University Hospital, Uppsala, Sweden.
Insights
Primary heart valve replacement survival is influenced by factors like age and symptoms. Patients over 70 or with mild symptoms show survival rates similar to the general population.
Area of Science:
- Cardiovascular Surgery
- Outcomes Research
Background:
- Optimal timing for primary heart valve replacement remains a critical clinical question.
- Understanding long-term survival and excess mortality post-valve replacement is essential for patient management.
Purpose of the Study:
- To analyze early and late survival after primary heart valve replacement.
- To evaluate excess mortality in heart valve replacement patients compared to the general population.
Main Methods:
- Survival analysis of 2365 patients undergoing first-time heart valve replacement.
- Comparison of observed survival with expected survival from the Swedish general population, stratified by demographics and time.
- Utilized Cox proportional hazards model for multivariate analysis of late survival factors.
Main Results:
- Early mortality rates varied: 5.9% (aortic), 10.4% (mitral), 10.6% (combined).
- 10-year relative survival rates (excluding early deaths) were 84% (aortic), 68.5% (mitral), and 80.9% (combined).
- Factors influencing late survival included concomitant coronary artery bypass grafting (CABG), NYHA class, atrial fibrillation, aortic regurgitation, and age.
Conclusions:
- Relative survival rates offer a different perspective on subgroup differences compared to observed rates.
- Patients aged >= 70 or with mild/no symptoms undergoing aortic or mitral valve replacement demonstrated survival comparable to the general Swedish population for extended periods.
Objective:
Determination of the optimal timing of primary heart valve replacement is an important issue. The present paper provides a synopsis over early and late survival after primary heart valve replacement, including an evaluation of the excess mortality among heart valve replacement patients compared with the general population.
Methods:
Survival was analyzed in 2365 patients (1568 without and 797 with concomitant coronary artery bypass grafting (CABG)) who underwent their first heart valve replacement. Observed survival was related to that expected among persons from the general Swedish population stratified by age, sex, and 5-year calendar period, to calculate the relative survival and estimate the disease-specific survival.
Results:
Early mortality (death within 30 days after surgery) was 5.9% after aortic valve replacement, 10.4% after mitral valve replacement and 10.6% after combined aortic and mitral valve replacement. Relative survival rates (excluding early deaths) were 84% 10 years after aortic, 68.5% after mitral and 80.9% after both aortic and mitral valve replacement. A multivariate model based on observed survival rates was produced for each group, using the Cox proportional hazards model. Concomitant CABG, advanced New York Heart Association (NYHA) class, preoperative atrial fibrillation, pure aortic regurgitation and higher age increased the late observed survival after aortic valve replacement. NYHA class was the only factor independently related to observed late deaths after mitral valve replacement, and mitral insufficiency the only corresponding factor after both aortic and mitral valve surgery.
Conclusion:
The use of relative survival rates tended to modify the difference between subgroups compared with observed survival rates. Relative survival rates reduced the effect of concomitant CABG on survival, but enhanced for example the effect of aortic regurgitation. In patients > or = 70 years of age and patients submitted to aortic or mitral valve replacement with mild or no symptoms, the survival rate was similar for many years to that in the Swedish population at large.
