Long-term relative survival rates after heart valve replacement

Department of Thoracic Surgery, Karolinska Hospital, Stockholm, Sweden.

The calculation and comparison of relative survival rates after interventional studies is a method that permits correction for important demographic variables, thereby adjusting for the "background mortality" in the general population. Long-term relative survival rates were analyzed in a consecutive series of 2,805 Swedish patients who, on the basis of clinical symptoms, underwent aortic valve replacement (n = 1,741), mitral valve replacement (n = 792) and double (aortic plus mitral) valve replacement (n = 272) between 1969 and 1983. The follow-up period, which closed August 1, 1985, included 100% of patients and covered 16,822 patient-years. Autopsy was performed in 75% of all deaths. The results underscore previously well known differences between the long-term survival after aortic valve replacement and mitral or double valve replacement, whereas no differences were noted between mitral and double valve replacement. Within the subgroup undergoing aortic valve replacement, analysis of relative survival rates disclosed a highly significant (p less than 0.001) difference between patients operated on for aortic stenosis and those operated on for aortic regurgitation, representing a mortality rate more than twice as high in the latter group. This difference was of much lesser magnitude when analyzed in the standard (actuarial) way. With a low (less than 2.5%) operative mortality rate for patients undergoing isolated elective aortic valve replacement in the current era and with an acceptable incidence of late valve-related death (5.2% at 10 years), these results may justify aortic valve replacement earlier in the course of chronic aortic regurgitation to prevent irreversible myocardial damage.(ABSTRACT TRUNCATED AT 250 WORDS)

This article has been cited by other articles:

				J. P. Dal-Bianco, B. K. Khandheria, F. Mookadam, F. Gentile, and P. P. Sengupta Management of Asymptomatic Severe Aortic Stenosis J. Am. Coll. Cardiol., October 14, 2008; 52(16): 1279 - 1292. [Abstract] [Full Text] [PDF]

				S. H. Rahimtoola Valvular heart disease: a perspective on the asymptomatic patient with severe valvular aortic stenosis Eur. Heart J., July 2, 2008; 29(14): 1783 - 1790. [Abstract] [Full Text] [PDF]

				B. A. Carabello Aortic Stenosis: Two Steps Forward, One Step Back Circulation, June 5, 2007; 115(22): 2799 - 2800. [Full Text] [PDF]

				L. A. Cuniberti, P. G. Stutzbach, E. Guevara, G. G. Yannarelli, R. P. Laguens, and R. R. Favaloro Development of Mild Aortic Valve Stenosis in a Rabbit Model of Hypertension J. Am. Coll. Cardiol., June 6, 2006; 47(11): 2303 - 2309. [Abstract] [Full Text] [PDF]

				I. Martinovic, I. Farah, M. Everlien, S. Lindemann, I. Knez, T. Wittlinger, H. Greve, and P. Vogt Eight-year results after aortic valve replacement with the CryoLife-O'Brien Stentless Aortic Porcine Bioprosthesis J. Thorac. Cardiovasc. Surg., September 1, 2005; 130(3): 777 - 777. [Abstract] [Full Text] [PDF]

				D. Weisenberg, Y. Sahar, G. Sahar, Y. Shapira, Z. Iakobishvili, B. A. Vidne, and A. Sagie Atherosclerosis of the aorta is common in patients with severe aortic stenosis: An intraoperative transesophageal echocardiographic study J. Thorac. Cardiovasc. Surg., July 1, 2005; 130(1): 29 - 32. [Abstract] [Full Text] [PDF]

				R. V. Freeman and C. M. Otto Spectrum of Calcific Aortic Valve Disease: Pathogenesis, Disease Progression, and Treatment Strategies Circulation, June 21, 2005; 111(24): 3316 - 3326. [Full Text] [PDF]

				W. T. Smith IV, T. B. Ferguson Jr, T. Ryan, C. K. Landolfo, and E. D. Peterson Should coronary artery bypass graft surgery patients with mild or moderate aortic stenosis undergo concomitant aortic valve replacement?: A decision analysis approach to the surgical dilemma J. Am. Coll. Cardiol., September 15, 2004; 44(6): 1241 - 1247. [Abstract] [Full Text] [PDF]

				B. A. Carabello Is it ever too late to operate on the patient with valvular heart disease? J. Am. Coll. Cardiol., July 21, 2004; 44(2): 376 - 383. [Abstract] [Full Text] [PDF]

				C. Seiler Management and follow up of prosthetic heart valves Heart, July 1, 2004; 90(7): 818 - 824. [Full Text] [PDF]

				A. R. Akar, A. Szafranek, C. Alexiou, R. Janas, M. J. Jasinski, J. Swanevelder, and A. W. Sosnowski Use of stentless xenografts in the aortic position: determinants of early and late outcome Ann. Thorac. Surg., November 1, 2002; 74(5): 1450 - 1457. [Abstract] [Full Text] [PDF]

				R. Rosenhek, G. Maurer, and H. Baumgartner Should early elective surgery be performed in patients with severe but asymptomatic aortic stenosis? Eur. Heart J., September 2, 2002; 23(18): 1417 - 1421. [Full Text] [PDF]

				B. A. Carabello Evaluation and Management of Patients With Aortic Stenosis Circulation, April 16, 2002; 105(15): 1746 - 1750. [Full Text] [PDF]

				E. G. Butchart, N. Payne, H.-H. Li, K. Buchan, K. Mandana, and G. L. Grunkemeier Better anticoagulation control improves survival after valve replacement J. Thorac. Cardiovasc. Surg., April 1, 2002; 123(4): 715 - 723. [Abstract] [Full Text]

				B. A. Carabello Aortic Stenosis N. Engl. J. Med., February 28, 2002; 346(9): 677 - 682. [Full Text] [PDF]

				P. Groves VALVE DISEASE: Surgery of valve disease: late results and late complications Heart, December 1, 2001; 86(6): 715 - 721. [Full Text] [PDF]

				C. Huth, A. Friedl, A. Rost, and for the GELIA Study Investigator Group Intensity of oral anticoagulation after implantation of St. Jude Medical aortic prosthesis: analysis of the GELIA Database (GELIA 4) Eur. Heart J. Suppl., December 1, 2001; 3(suppl_Q): Q33 - Q38. [Abstract] [PDF]

				J. CHAMBERS and P. DAS Treadmill exercise in apparently asymptomatic aortic stenosis Heart, October 1, 2001; 86(4): 361 - 362. [Full Text] [PDF]

				S Takeda, H Rimington, N Smeeton, and J Chambers Long axis excursion in aortic stenosis Heart, July 1, 2001; 86(1): 52 - 56. [Abstract] [Full Text] [PDF]

				R Corti, C Binggeli, M Turina, R Jenni, T.F Luscher, and J Turina Predictors of long-term survival after valve replacement for chronic aortic regurgitation. Is M-mode echocardiography sufficient? Eur. Heart J., May 2, 2001; 22(10): 866 - 873. [Abstract] [PDF]

				A. P. Kappetein, J. Braun, L. H.B. Baur, A. Prat, K. Peels, M. G. Hazekamp, P. H. Schoof, and H. A. Huysmans Outcome and follow-up of aortic valve replacement with the freestyle stentless bioprosthesis Ann. Thorac. Surg., February 1, 2001; 71(2): 601 - 608. [Abstract] [Full Text] [PDF]

				N. J.O. Birkmeyer, J. D. Birkmeyer, A. N.A. Tosteson, G. L. Grunkemeier, C. A.S. Marrin, and G. T. O'Connor Prosthetic valve type for patients undergoing aortic valve replacement: a decision analysis Ann. Thorac. Surg., December 1, 2000; 70(6): 1946 - 1952. [Abstract] [Full Text] [PDF]

				R. Rosenhek, T. Binder, G. Porenta, I. Lang, G. Christ, M. Schemper, G. Maurer, and H. Baumgartner Predictors of Outcome in Severe, Asymptomatic Aortic Stenosis N. Engl. J. Med., August 31, 2000; 343(9): 611 - 617. [Abstract] [Full Text] [PDF]

				P. Kvidal, R. Bergstrom, L.-G. Horte, and E. Stahle Observed and relative survival after aortic valve replacement J. Am. Coll. Cardiol., March 1, 2000; 35(3): 747 - 756. [Abstract] [Full Text] [PDF]

				K. L. Yun, C. F. Sintek, A. D. Fletcher, T. A. Pfeffer, G. S. Kochamba, M. R. Hyde, J. O. Torpoco, and S. Khonsari Aortic Valve Replacement With the Freestyle Stentless Bioprosthesis : Five-Year Experience Circulation, November 9, 1999; 100(90002): II-17 - 23. [Abstract] [Full Text] [PDF]

				C.F. Vahl, T. Kloss, Y. Yang, M. Castell, A. Mehrkens, R. deSimone, L. Schaffer, and S. Hagl Surgical treatment of oligosymptomatic mitral valve incompetence? Eur. J. Cardiothorac. Surg., November 1, 1999; 16(5): 524 - 532. [Abstract] [Full Text] [PDF]

				A. W.J. van't Hof, F. G. Leicher, C. W. Schipper, and J. C.A. Hoorntje Presentation of a pseudoaneurysm as a supravalvular aortic stenosis 20 years after aortic root reconstruction Eur. J. Cardiothorac. Surg., April 1, 1999; 13(4): 481 - 483. [Abstract] [Full Text] [PDF]

				S. Westaby, X. Y. Jin, T. Katsumata, A. Arifi, and P. Braidley Valve replacement with a stentless bioprosthesis: Versatility of theporcine aortic root J. Thorac. Cardiovasc. Surg., September 1, 1998; 116(3): 477 - 481. [Abstract] [Full Text]

				J. W. Tam, R. G. Masters, I. G. Burwash, A. D. Mayhew, and K.-L. Chan Management of Patients With Mild Aortic Stenosis Undergoing Coronary Artery Bypass Grafting Ann. Thorac. Surg., May 1, 1998; 65(5): 1215 - 1219. [Abstract] [Full Text] [PDF]

				S. Westaby, H. A. Huysmans, and T. E. David Stentless Aortic Bioprostheses: Compelling Data From the Second International Symposium Ann. Thorac. Surg., January 1, 1998; 65(1): 235 - 235. [Abstract] [Full Text] [PDF]

				B. A. Carabello and F. A. Crawford Valvular Heart Disease N. Engl. J. Med., July 3, 1997; 337(1): 32 - 41. [Full Text] [PDF]

				B. A. Carabello Timing of Valve Replacement in Aortic Stenosis : Moving Closer to Perfection Circulation, May 6, 1997; 95(9): 2241 - 2243. [Full Text]

				M. Kaps, J. Hansen, M. Weiher, K. Tiffert, I. Kayser, and D. W. Droste Clinically Silent Microemboli in Patients With Artificial Prosthetic Aortic Valves Are Predominantly Gaseous and Not Solid Stroke, February 1, 1997; 28(2): 322 - 325. [Abstract] [Full Text]

				B. A. Carabello Aortic Regurgitation in Women: Does the Measuring Stick Need a Change? Circulation, November 15, 1996; 94(10): 2355 - 2357. [Full Text]

				S. F. Bolling, G. M. Deeb, L. A. Brunsting, and D. S. Bach Early outcome of mitral valve reconstruction in patients with end-stage cardiomyopathy J. Thorac. Cardiovasc. Surg., April 1, 1995; 109(4): 676 - 683. [Abstract] [Full Text]