Valvular & structural heart disease
Life expectancy and determinants of relative survival following surgical aortic valve replacement for aortic stenosis
Authors' conclusion
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.
Study context
- Population
- Patients undergoing Surgical Aortic Valve Replacement (SAVR) for ≥moderate Aortic Stenosis (AS), Western Australian Heart Valves Study databasemedian age 71 (63–77) years, 32% female
- Participants
- 1,287 patients
- Comparison
- Long-term relative survival following SAVR compared with the general population
- SAVRn = 1,287
- Outcome
- Deaths
- Follow-up
- Median 47 (23-81) months
Main finding
As reported in the abstract
SAVR
19%
247 of 1287
Further findings
Independent predictors of long-term excess mortality relative to the national comparator
| Excess HR (95% CI) | P value | ||
|---|---|---|---|
| LVEF 45%-60%Flexible multivariable modelling | 1.97 (1.11–3.51) | P = 0.02 | |
| LVEF 30%-45%Flexible multivariable modelling | 2.40 (1.24–4.64) | P = 0.01 | |
| LVEF <30%Flexible multivariable modelling | 2.96 (1.18–7.39) | P = 0.02 | |
| Significant MRFlexible multivariable modelling | 2.28 (1.29–4.03) | P = 0.005 | |
| Indigenous statusFlexible multivariable modelling | 4.53 (2.03–10.12) | P < 0.001 | |
| Diabetes mellitusFlexible multivariable modelling | 2.30 (1.44–3.68) | P < 0.001 | |
| eGFR 30-59 mL/kg/1.73 m 2Flexible multivariable modelling | 2.74 (1.33–5.65) | P = 0.006 | |
| eGFR 0-29 mL/kg/1.73 m 2Flexible multivariable modelling | 5.75 (2.36–13.99) | P < 0.001 | |
| 0.050.21520Excess HR (log scale) |
All-cause relative survival
- 30-day
- 97.3%
- 1-year
- 97.2%
- 5-year
- 93.0%
- 10-year
- 83.3%
- Compared with an age-matched, sex-matched and year-matched general population
Independent predictors of long-term excess mortality relative to the national comparator
- Age, sex, year of surgery, concomitant coronary artery bypass graft surgery and symptom status were not associated
Original publication
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