title: Long-term survival after surgical aortic valve replacement among patients over 65 years of age.
abstract: Surgical aortic valve replacement (AVR) remains the gold standard therapy for severe aortic stenosis. Long-term survival data following AVR is required. Our objective was to provide a detailed contemporary benchmark of long-term survival following AVR among elderly patients (≥65 years) in the UK.
  
  
  
  We conducted a retrospective cohort study of 1815 adult patients undergoing surgical AVR± coronary artery bypass graft (CABG) surgery at a single UK centre between 1996 and 2011. Our main outcome was patient survival, which was assessed by linkage to census records at the Office for National Statistics.
  
  
  
  The mean age of the cohort was 75 (±5.6) years. Patients in the AVR alone group had a slightly higher median survival of 10.9 (95% CI 10.5 to 11.8) years than the AVR+CABG group which had a median survival of 9.6 (95% CI 8.7 to 10.1) years (p=0.001 of log-rank test (LRT) for equality of survivor functions). The presence of chronic kidney disease, severely impaired left ventricular function or being a current smoker were each associated with a ≥50% increased risk of long-term mortality. Comparison of our study cohort patients and the reference (operation year, age and gender matched) UK population suggested no difference in survival probability up to 8 years (p=0.55). However, for longer periods of follow-up, the difference became increasingly significant (p<0.0001).
  
  
  
  Long-term survival following surgical AVR in patients over 65 years of age is excellent and up to 8 years is comparable to the matched general population.
authors.affiliation: Academic Cardiac Surgery , National Heart & Lung Institute, Imperial College London , London , UK.
authors.forename: Mansour T A
authors.initials: MT
authors.lastname: Sharabiani
authors.affiliation: Academic Cardiac Surgery , National Heart & Lung Institute, Imperial College London , London , UK.
authors.forename: Francesca
authors.initials: F
authors.lastname: Fiorentino
authors.affiliation: Academic Cardiac Surgery, National Heart & Lung Institute, Imperial College London, London, UK; Bristol Heart Institute, University of Bristol, Bristol, UK.
authors.forename: Gianni D
authors.initials: GD
authors.lastname: Angelini
authors.affiliation: Academic Cardiac Surgery , National Heart & Lung Institute, Imperial College London , London , UK.
authors.forename: Nishith N
authors.initials: NN
authors.lastname: Patel
keywords: QUALITY OF CARE AND OUTCOMES