CLINICAL STUDIES
Observed and relative survival after aortic valve replacement
Per Kvidal, MD*,
Prof. Reinhold Bergström, PhD ,
Lars-Gunnar Hörte, BA, PM and
Elisabeth Ståhle, MD, PhD
* Department of Cardiology, University Hospital, Uppsala, Sweden
Department of Thoracic and Cardiovascular Surgery, University Hospital, Uppsala, Sweden
Department of Statistics, University of Uppsala, Uppsala, Sweden
Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden
Manuscript received April 22, 1999;
revised manuscript received September 20, 1999,
accepted November 3, 1999.
Reprint requests and correspondence: Dr. Per Kvidal, Department of Cardiology, University Hospital, S-751 85, Uppsala, Sweden
elisabeth.stahle{at}thorax.uas.lul.se
per_kvidal{at}hotmail.com
OBJECTIVES
We sought to evaluate the effects of a number of factors that can potentially determine the optimal time for aortic valve replacement (AVR) and the observed and relative survival after the operation.
BACKGROUND
Aortic valve replacement is performed in patients within a wide age span, but the proportion of elderly patients is increasing. In survival analyses, adjustment for the effects of age is therefore essential. Analysis of relative survival provides additional information on excess or disease-specific mortality and its risk factors.
METHODS
Survival was analyzed in 2,359 patients (1,442 without and 917 with concomitant coronary artery bypass graft surgery) undergoing their first AVR. By relating observed survival to that expected among the general Swedish population stratified by age, gender and five-year calendar period, the relative survival and disease-specific survival were estimated.
RESULTS
Early mortality after AVR (death within 30 days) was 5.6%. Relative survival rates (excluding early deaths) after 5, 10 and 15 years were 94.6%, 84.7% and 74.9%, respectively. There was an excess risk of dying during the entire follow-up period. Advanced New York Heart Association functional class, preoperative atrial fibrillation and pure aortic regurgitation were independent risk factors for observed and relative survival. Patients in the oldest age group showed decreased observed survival but excellent relative survival.
CONCLUSIONS
Old age was not a risk factor for excess mortality after AVR, whereas atrial fibrillation decreased relative survival substantially.
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Abbreviations and Acronyms
| | AF | = atrial fibrillation | | AVR | = aortic valve replacement | | CABG | = coronary artery bypass graft surgery | | CI | = confidence interval | | NYHA | = New York Heart Association | | OR | = odds ratio | | RH | = relative hazard |
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