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.
Cohort (n=23,528)
Yes
Does primary surgical aortic valve replacement result in a loss of life expectancy compared to the matched general population?
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.
Effect estimate: 1.9 years (95% CI 1.2 to 2.6)
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).
“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.”
Glaser et al. (Mon,) 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.