Author + information
- Received March 14, 2019
- Revision received April 8, 2019
- Accepted April 9, 2019
- Published online July 1, 2019.
- Natalie Glaser, MD, PhDa,b,∗ (, )@Sodersjukhuset,
- Michael Persson, MDb,c,
- Veronica Jackson, MD, PhDb,
- Martin J. Holzmann, MD, PhDd,e,
- Anders Franco-Cereceda, MD, PhDb,c and
- Ulrik Sartipy, MD, PhDb,c
- aDepartment of Cardiology, Södersjukhuset, Stockholm, SwedenDepartment of Cardiology, Sodersjukhuset, Stockholm, Sweden
- bDepartment of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, SwedenDepartment of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- cHeart and Vascular Theme, Karolinska University Hospital, Stockholm, SwedenHeart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
- dFunctional Area of Emergency Medicine, Karolinska University Hospital, Huddinge, Stockholm, SwedenFunctional Area of Emergency Medicine, Karolinska University Hospital, Huddinge, Stockholm, Sweden
- eDepartment of Internal Medicine, Karolinska Institutet, Stockholm, SwedenDepartment of Internal Medicine, Karolinska Institutet, Stockholm, Sweden
- ↵∗Address for correspondence:
Dr. Natalie Glaser, Department of Cardiology, Södersjukhuset, Sjukhusbacken 10, SE-118 83 Stockholm, Sweden.
Background Contemporary data on loss in life expectancy after aortic valve replacement (AVR) are scarce, particularly in younger patients.
Objectives The purpose of this national, observational cohort study was to analyze long-term relative survival and estimated loss in life expectancy after AVR.
Methods The study included 23,528 patients who underwent primary surgical AVR with or without concomitant coronary artery bypass grafting in Sweden between 1995 and 2013 from the SWEDEHEART (Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies) register. Individual level linking with other national health-data registers was performed to obtain baseline characteristics and vital status. The expected survival from the general Swedish population matched by age, sex, and year of surgery was obtained from the Human Mortality Database. The relative survival was used as an estimate of cause-specific mortality. Flexible parametric models based on relative survival were used to estimate the loss in life expectancy.
Results The mean follow-up was 6.8 years. The 19-year observed, expected, and relative survival was 21%, 34%, and 63% (95% confidence interval [CI]: 59% to 67%), respectively. The loss in life expectancy was 1.9 years (95% CI: 1.2 to 2.6 years) in the total study population. The estimated loss in life expectancy increased with younger age: 0.4 years (95% CI: 0.3 to 0.5 years) versus 4.4 years (95% CI: 1.5 to 7.2 years) in patients ≥80 and <50 years of age, respectively. There was no difference in loss in life expectancy between men and women.
Conclusions This study found a shorter life expectancy in patients after AVR compared with the general population. The estimated loss in life expectancy was substantial, and increased with younger age. These results provide important information to quantify disease burden after AVR, and are relevant for clinicians counseling patients before and after AVR. (HeAlth-data Register sTudies of Risk and Outcomes in Cardiac Surgery [HARTROCS]; NCT02276950)
This work was supported by the Swedish Heart-Lung Foundation (grant numbers 20160522 and 20160525 [to Dr. Sartipy] and 20170804 [to Dr. Holzmann]); the Mats Kleberg Foundation (grant number 2017-00096 [to Dr. Sartipy]); Karolinska Institutet Foundations and Funds (grant numbers 2016fobi47721 [to Dr. Sartipy] and 2018-01530 [to Dr. Jackson]); Swedish Heart and Lung Association (grant number E101/16 to [to Drs. Sartipy and Glaser]); Åke Wiberg Foundation (grant number M17-0089 [to Dr. Sartipy]); Magnus Bergvall Foundation (grant number 2017-02054 [to Dr. Sartipy]); the regional ALF agreement between Stockholm County Council and Karolinska Institutet (grant number 20160329 [to Dr. Sartipy]); the Stockholm County Council (grant number 20170686 [to Dr. Holzmann]); and a donation from Mr. Fredrik Lundberg to Dr. Franco-Cereceda. The sponsors had no role in the design or conduct of this study. Dr. Holzmann has received consultancy honoraria from Actelion, Idorsia, and Pfizer. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.
- Received March 14, 2019.
- Revision received April 8, 2019.
- Accepted April 9, 2019.
- 2019 American College of Cardiology Foundation
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