LONG-TERM RELATIVE SURVIVAL AFTER PRIMARY HEART-VALVE REPLACEMENT

Objective: Determination of the optimal timing of primary heart valve replacement is an important issue. The present paper provides a synops is over early and late survival after primary heart valve replacement, including an evaluation of the excess mortality among heart valve rep lacement patients compared with the general population. Methods: Survi val was analyzed in 2365 patients (1568 without and 797 with concomita nt coronary artery bypass grafting (CABG)) who underwent their first h eart valve replacement. Observed survival was related to that expected among persons from the general Swedish population stratified by age, sex, and 5-year calendar period, to calculate the relative survival an d estimate the disease-specific survival. Results: Early mortality (de ath within 30 days after surgery) was 5.9% after aortic valve replacem ent, 10.4% after mitral valve replacement and 10.6% after combined aor tic and mitral valve replacement. Relative survival rates (excluding e arly deaths) were 84% 10 years after aortic, 68.5% after mitral and 80 .9% after both aortic and mitral valve replacement. A multivariate mod el based on observed survival rates was produced for each group, using the Cox proportional hazards model. Concomitant CABG, advanced New Yo rk Heart Association (NYHA) class, preoperative atrial fibrillation, p ure aortic regurgitation and higher age increased the late observed su rvival after aortic valve replacement. NYHA class was the only factor independently related to observed late deaths after mitral valve repla cement, and mitral insufficiency the only corresponding factor after b oth aortic and mitral valve surgery. Conclusion: The use of relative s urvival rates tended to modify the difference between subgroups compar ed with observed survival rates. Relative survival rates reduced the e ffect of concomitant CABG on survival, but enhanced for example the ef fect of aortic regurgitation. In patients greater than or equal to 70 years of age and patients submitted to aortic or mitral valve replacem ent with mild or no symptoms, the survival rate was similar for many y ears to that in the Swedish population at large. Copyright (C) 1997 El sevier Science B.V.