title: Perioperative and long-term outcomes following aortic valve replacement: a population cohort study of 4124 consecutive patients.
abstract: OBJECTIVE
  Because of increasing life expectancy, more patients require valve replacement for aortic stenosis. We aimed to determine perioperative and long-term outcomes, the factors associated with these and whether they have changed over time.
  
  
  METHODS
  We undertook a retrospective cohort study of all 4124 patients, who underwent isolated, primary aortic valve replacement in Scotland between April 1996 and March 2009 inclusive.
  
  
  RESULTS
  Annual operations increased by 68%, from 261 to 439. The overall risk of dying within 30 days, 5 years and 10 years was 3.4%, 19.9% and 38.5%, respectively. Over 10 years' follow-up, 4.4% underwent further valve surgery, 7.9% suffered a stroke and 5.3% a myocardial infarction. Age, renal impairment and urgency were predictors of both perioperative and long-term death. Perioperative death was associated with left-ventricular impairment and long-term death with respiratory disease, diabetes and deprivation. Over the 13 years, there was an increase in median age (from 66 to 69 years, p < 0.001), diabetes (from 1.9% to 12.6%, p < 0.001), hypertension (from 26.4% to 56.1%, p < 0.001), cerebrovascular disease (from 3.7% to 9.8%, p < 0.001), respiratory disease (from 6.6% to 9.7%, p = 0.020) and previous myocardial infarction (from 0.6% to 5.8%, p < 0.001), but the risk of perioperative death fell from 6.5% to 3.1% (odds ratio (OR) 0.87, 95% confidence interval (CI) 0.83, 0.92, p < 0.001) per year.
  
  
  CONCLUSIONS
  Patients undergoing aortic valve replacement have a poor risk profile. Over time, their numbers, age and co-morbidity have increased. In spite of these, there has been a significant reduction in the risk of perioperative death.
authors.affiliation: Centre for Population Health Sciences, University of Glasgow, Glasgow, UK.
authors.forename: Ross C
authors.initials: RC
authors.lastname: McLean
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Briggs
authors.forename: Rachel
authors.initials: R
authors.lastname: Slack
authors.forename: Vipin
authors.initials: V
authors.lastname: Zamvar
authors.forename: Geoffrey A
authors.initials: GA
authors.lastname: Berg
authors.forename: Hussein
authors.initials: H
authors.lastname: El-Shafei
authors.forename: Keith G
authors.initials: KG
authors.lastname: Oldroyd
authors.forename: Jill P
authors.initials: JP
authors.lastname: Pell
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D001705:Bioprosthesis; D015897:Comorbidity; D004812:Epidemiologic Methods; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000401:mortality / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012086:Reoperation / Q000706:statistics & numerical data; D012606:Scotland / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult