Observed and relative survival after aortic valve replacement

J Am Coll Cardiol. 2000 Mar 1;35(3):747-56. doi: 10.1016/s0735-1097(99)00584-7.


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.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Aortic Valve* / surgery
  • Bioprosthesis
  • Cause of Death
  • Coronary Artery Bypass
  • Coronary Disease / complications
  • Coronary Disease / mortality
  • Coronary Disease / surgery
  • Female
  • Heart Valve Diseases / complications
  • Heart Valve Diseases / mortality
  • Heart Valve Diseases / surgery
  • Heart Valve Prosthesis
  • Heart Valve Prosthesis Implantation / mortality*
  • Humans
  • Male
  • Middle Aged
  • Postoperative Complications / mortality
  • Prospective Studies
  • Risk Factors
  • Survival Rate
  • Sweden / epidemiology