Life expectancy and determinants of relative survival following surgical aortic valve replacement for aortic stenosis.
retrospective_cohort · Level III
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- Record sourced from PubMed, PMID 41850785.
- Also identified by DOI 10.1136/heartjnl-2025-327029.
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Abstract
Surgical aortic valve replacement (SAVR) improves survival in severe, symptomatic aortic stenosis (AS), but whether it fully restores life expectancy is uncertain. This study aimed to evaluate long-term relative survival following SAVR compared with the general population and identify predictors of any residual survival discrepancies. A total of 1287 patients (median age 71 (63-77) years, 32% female) undergoing SAVR for ≥moderate AS were identified from the Western Australian Heart Valves Study database. Flexible parametric models were used to estimate relative survival. Over a median follow-up of 47 (23-81) months, 247 (19%) patients died. All-cause 30-day, 1-year, 5-year and 10-year relative survivals were 97.3%, 97.2%, 93.0% and 83.3%, respectively, compared with an age-matched, sex-matched and year-matched general population. Flexible multivariable modelling indicated impaired left ventricular ejection fraction (LVEF) (45%-60%, excess HR 1.97, 95% CI 1.11 to 3.51, p=0.02; 30%-45%, excess HR 2.40, 95% CI 1.24 to 4.64, p=0.01; <30%, excess HR 2.96, 95% CI 1.18 to 7.39, p=0.02), significant mitral regurgitation (MR) (excess HR 2.28, 95% CI 1.29 to 4.03, p=0.005), Indigenous status (excess HR 4.53, 95% CI 2.03 to 10.12, p<0.001), diabetes mellitus (excess HR 2.30, 95% CI 1.44 to 3.68, p<0.001), estimated glomerular filtration rate (eGFR) 30-59 mL/kg/1.73 m<sup>2</sup> (excess HR 2.74, 95% CI 1.33 to 5.65, p=0.006) and eGFR 0-29 mL/kg/1.73 m<sup>2</sup> (excess HR 5.75, 95% CI 2.36 to 13.99, p<0.001) were independently associated with long-term excess mortality relative to that of the national comparator, whereas age, sex, year of surgery, concomitant coronary artery bypass graft surgery and symptom status were not. 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.