Observed and relative survival after aortic valve replacement

OBJECTIVES We sought to evaluate the effects of a number of factors that ca n 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. Analys is of relative survival provides additional information on excess or diseas e-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 A VR. By relating observed survival to that expected among the general Swedis h population stratified by age, gender and five-year calendar period, the r elative 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 th e oldest age group showed decreased observed survival but excellent-relativ e survival. CONCLUSIONS Old age was not a risk factor for excess mortality after AVR, w hereas atrial fibrillation decreased relative survival substantially. (C) 2 000 by the American College of Cardiology.