July 1, 2019Journal of the American College of Cardiology
Loss in Life Expectancy After Surgical Aortic Valve Replacement
Key result
Primary SAVR is linked to a ~1.9-year loss in life expectancy versus the general population.
- 1.9 years
- 95% CI 1.2 to 2.6
- n=23,528
Why the study?
Contemporary data on loss in life expectancy after aortic valve replacement were scarce, particularly in younger patients.
Does primary surgical aortic valve replacement result in a loss of life expectancy compared to the matched general population?
Key Points
- To analyze long-term relative survival and loss in life expectancy after aortic valve replacement (AVR).
- Included 23,528 patients undergoing primary surgical AVR in Sweden between 1995 and 2013.
- Linked individual data with national health-data registers for baseline characteristics and vital status.
- Utilized flexible parametric models based on relative survival to estimate loss in life expectancy.
- Mean follow-up was 6.8 years.
- 19-year relative survival was 63% (95% CI: 59% to 67%).
- Estimated overall loss in life expectancy was 1.9 years (95% CI: 1.2 to 2.6 years), with younger patients experiencing greater loss.
Study Design
Type
Cohort (n=23,528)
Multicenter
Yes
Structured PICO
Does primary surgical aortic valve replacement result in a loss of life expectancy compared to the matched general population?
P
Population
23,528 patients who underwent primary surgical AVR with or without concomitant CABG in Sweden, followed for a mean of 6.8 years.
E
Exposure
Primary surgical aortic valve replacement (AVR) with or without concomitant coronary artery bypass grafting
C
Comparator
General Swedish population matched by age, sex, and year of surgery
O
Outcome
Long-term relative survival and estimated loss in life expectancyhard clinical
Main Result
Effect estimate: 1.9 years (95% CI 1.2 to 2.6)
Patients undergoing surgical aortic valve replacement experience a substantial loss in life expectancy compared to the general population, with the greatest loss observed in younger patients.
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Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“It was surprising that the decrease in life expectancy was so pronounced in younger patients, and comparable to the life expectancy in patients diagnosed with breast or prostate cancer.”
“We can now inform patients more effectively about the long-term post-surgical prognosis. We might be able to tailor both pre- and post-surgical treatment better by, for example, taking care of risk factors and monitoring certain patients more closely for a longer time.”
“SAVR can effectively 'restore' life expectancy in elderly patients to an almost similar level of those not having severe AS.... This marked loss in life expectancy in younger SAVR patients compared with their healthy peers is thought-provoking and needs explanation.”
Implication
Long-term survival after AVR falls short of expected; extends age-stratified life expectancy data but leaves open effects of contemporary practice.
Abstract
BACKGROUND Contemporary data on loss in life expectancy after aortic valve replacement (AVR) are scarce, particularly in younger patients. OBJECTIVES The purpose of this national, observational cohort study was to analyze long-term relative survival and estimated loss in life expectancy after AVR. METHODS The study included 23,528 patients who underwent primary surgical AVR with or without concomitant coronary artery bypass grafting in Sweden between 1995 and 2013 from the SWEDEHEART (Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies) register. Individual level linking with other national health-data registers was performed to obtain baseline characteristics and vital status. The expected survival from the general Swedish population matched by age, sex, and year of surgery was obtained from the Human Mortality Database. The relative survival was used as an estimate of cause-specific mortality. Flexible parametric models based on relative survival were used to estimate the loss in life expectancy. RESULTS The mean follow-up was 6.8 years. The 19-year observed, expected, and relative survival was 21%, 34%, and 63% (95% confidence interval [CI]: 59% to 67%), respectively. The loss in life expectancy was 1.9 years (95% CI: 1.2 to 2.6 years) in the total study population. The estimated loss in life expectancy increased with younger age: 0.4 years (95% CI: 0.3 to 0.5 years) versus 4.4 years (95% CI: 1.5 to 7.2 years) in patients ≥80 and <50 years of age, respectively. There was no difference in loss in life expectancy between men and women. CONCLUSIONS This study found a shorter life expectancy in patients after AVR compared with the general population. The estimated loss in life expectancy was substantial, and increased with younger age. These results provide important information to quantify disease burden after AVR, and are relevant for clinicians counseling patients before and after AVR. (HeAlth-data Register sTudies of Risk and Outcomes in Cardiac Surgery [HARTROCS]; NCT02276950).
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Cite This Study
Glaser et al. (2019) conducted a cohort in Aortic valve replacement (n=23,528). Primary surgical aortic valve replacement vs. Matched general Swedish population was evaluated on Loss in life expectancy (1.9 years, 95% CI 1.2 to 2.6). Primary surgical aortic valve replacement was associated with a 1.9-year loss in life expectancy (95% CI: 1.2 to 2.6) compared with the matched general population.