title: Long-term absolute and relative survival after aortic valve replacement: a prospective cohort study.
abstract: BACKGROUND
  Aortic valve replacement is one of the most common cardiac surgical procedures, especially in elderly patients. Whether or not there is a net life gain over a long period of time is a matter for debate.
  
  
  OBJECTIVE
  To compare survival of patients with that of the age, sex, and follow-up year-matched normal population (relative survival).
  
  
  METHODS
  Single-centre, prospectively collected data.
  
  
  METHODS
  Tertiary care centre, Vienna, Austria.
  
  
  METHODS
  We enrolled 1848 patients undergoing elective aortic valve replacement between 1997 and the end of 2008.
  
  
  METHODS
  None.
  
  
  METHODS
  Relative survival at the end of 2011 as determined by relative Cox regression analysis.
  
  
  RESULTS
  Sixty-nine patients (3.7%) died within the first 30 days. Another 70 patients (3.8%) died within the first year and 429 (23.2%) died during the remaining follow-up period. The longest follow-up period was 14 years (median, 5.8; interquartile range, 3.2 to 8.9). Medical risk indicators for relative survival were diabetes mellitus [hazard ratio 1.69, 95% confidence interval, CI 1.37 to 2.07, P<0.001], pulmonary disease (hazard ratio 1.45, 95% CI 1.16 to 1.81, P=0.001), history of atrial fibrillation (hazard ratio 1.35, 95% CI 1.10 to 1.66, P=.005) and angiotensin-converting enzyme inhibitor medication (hazard ratio 1.21, 95% CI 1.02 to 1.44, P=0.031). Perioperative risk indicators were urgent surgery (hazard ratio 1.40, 95% CI 1.00 to 1.94, P=0.047), resternotomy at 48 h or less (hazard ratio 1.87, 95% CI 1.29 to 2.70, P=0.001), resternotomy at more than 48 h (hazard ratio 1.80, 95% CI 1.32 to 2.45, P<0.001), blood transfusion (hazard ratio 1.06, 95% CI 1.01 to 1.12, P=0.018) and renal replacement therapy (hazard ratio 2.02, 95% CI 1.41 to 2.90, P<0.001). Relative survival was highest in the oldest age quartile (76 to 94 years) and lowest in the youngest (19 to 58 years) (hazard ratio 0.27, 95% CI 0.21 to 0.36; P<0.001).
  
  
  CONCLUSIONS
  Patients who survived the first year after aortic valve replacement had a similar chance of survival as the matched normal population. Relative survival benefit was higher in the oldest age quartile.
authors.affiliation: From the Department of Cardiothoracic and Vascular Anaesthesia and Intensive Care Medicine, University Hospital of Vienna (AL,MH,MM), Institute of Medical Statistics, Medical University of Vienna (SF,WB), Clinical Institute of Infection Control and Hospital Epidemiology, University Hospital of Vienna, Vienna, Austria (EP), Anesthésie Réanimation Chirurgie Cardio-thoracique et Vasculaire, CHU Pierre Zobda-Quitman Fort de France, Martinique, France (CI), Horten Centre, University Hospital Zürich, Zürich, Switzerland (LMB), Department of Cardiac Surgery, University Hospital of Vienna, Vienna (MA), Department of Cardiac Surgery, University Hospital of Salzburg, Salzburg, Austria (RS), Anaesthesia and Intensive Care Medicine, Hirslanden Klinik Im Park, Zürich, Switzerland (DS).
authors.forename: Andrea
authors.initials: A
authors.lastname: Lassnigg
authors.forename: Michael
authors.initials: M
authors.lastname: Hiesmayr
authors.forename: Sophie
authors.initials: S
authors.lastname: Frantal
authors.forename: Werner
authors.initials: W
authors.lastname: Brannath
authors.forename: Mohamed
authors.initials: M
authors.lastname: Mouhieddine
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Presterl
authors.forename: Christian
authors.initials: C
authors.lastname: Isetta
authors.forename: Lucas M
authors.initials: LM
authors.lastname: Bachmann
authors.forename: Martin
authors.initials: M
authors.lastname: Andreas
authors.forename: Rainald
authors.initials: R
authors.lastname: Seitelberger
authors.forename: Daniel
authors.initials: D
authors.lastname: Schmidlin
mesh_terms: D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D005260:Female; D006349:Heart Valve Diseases / Q000401:mortality / Q000628:therapy*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012306:Risk; D016896:Treatment Outcome; D055815:Young Adult