Background: Surgical risk, age, perceived life expectancy, and valve durability influence the choice between surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation. The contemporaneous life expectancy after SAVR, in relation to surgical risk and age, is unknown. Objectives: The purpose of this study was to determine median survival time in relation to surgical risk and chronological age in SAVR patients. Methods: Patients ≥60 years with aortic stenosis who underwent isolated SAVR with a bioprosthesis (n = 8,353) were risk-stratified before surgery into low, intermediate, or high surgical risk using the logistic EuroSCORE (2001-2011) or EuroSCORE II (2012-2017) and divided into age groups. Median survival time and cumulative 5-year mortality were estimated with Kaplan-Meier curves. Cox regression analysis was used to further determine the importance of age. Results: There were 7,123 (85.1%) low-risk patients, 942 (11.3%) intermediate-risk patients, and 288 (3.5%) high-risk patients. Median survival time was 10.9 years (95% confidence interval: 10.6-11.2 years) in low-risk, 7.3 years (7.0-7.9 years) in intermediate-risk, and 5.8 years (5.4-6.5 years) in high-risk patients. The 5-year cumulative mortality was 16.5% (15.5%-17.4%), 30.7% (27.5%-33.7%), and 43.0% (36.8%-48.7%), respectively. In low-risk patients, median survival time ranged from 16.2 years in patients aged 60 to 64 years to 6.1 years in patients aged ≥85 years. Age was associated with 5-year mortality only in low-risk patients (interaction P < 0.001). Conclusions: Eighty-five percent of SAVR patients receiving bioprostheses have low surgical risk. Estimated survival is substantial following SAVR, especially in younger, low-risk patients, which should be considered in Heart Team discussions.
Bibliographical noteFunding Information:
This work was supported by grants from The Swedish Heart-Lung Foundation (20180560 to Dr Jeppsson and 201604 to Dr Nielsen), The Swedish state under the agreement between the Swedish government and the county councils concerning economic support of research and education of doctors (ALF agreement) (ALFGBG-725131 to Dr Jeppsson), and Västra Götaland Region (VGFOUREG-847811 and VGFOUREG-665591 to Dr Jeppsson), and Family Nils Winberg’s Foundation. The supporting bodies had no influence on the analysis and interpretation of data, on the writing of the report, or on the decision to submit the paper for publication. Dr Omerovic has received an institutional research grant from AstraZeneca; has received consultancy fees from Bayer and Novartis; and has received speaker honorarium from Merck, Sharp & Dohme, all outside the present work. Dr Dellgren has received an institutional grant for the SweVAD study from Abbott; and has received an institutional grant for the ScanCLAD study from Astellas. Dr Dellgren has received speaker's fees from XVIVO, all outside the present work. Dr Milojevic has received speaker’s fees from LivaNova outside the present work. Dr Jeppsson has received fees for consultancy or lectures from Werfen, Boehringer Ingelheim, Portola, Baxter, and LFB Biomedicaments, all unrelated to the present work. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
© 2021 The Authors