Medizinische Universität Graz - Research portal
Selected Publication:
SHR Neuro Cancer Cardio Lipid Metab Microb
Lassnigg, A; Hiesmayr, M; Frantal, S; Brannath, W; Mouhieddine, M; Presterl, E; Isetta, C; Bachmann, LM; Andreas, M; Seitelberger, R; Schmidlin, D.
Long-term absolute and relative survival after aortic valve replacement A prospective cohort study
EUR J ANAESTH. 2013; 30(11): 695-703.
Doi: 10.1097/EJA.0b013e3283657829
Web of Science
PubMed
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- Co-authors Med Uni Graz
- Andreas Martin
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- Abstract:
- BACKGROUNDAortic 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.OBJECTIVETo compare survival of patients with that of the age, sex, and follow-up year-matched normal population (relative survival).DESIGNSingle-centre, prospectively collected data.SETTINGTertiary care centre, Vienna, Austria.PATIENTSWe enrolled 1848 patients undergoing elective aortic valve replacement between 1997 and the end of 2008.INTERVENTIONSNone.MAIN OUTCOME MEASUREMENTRelative survival at the end of 2011 as determined by relative Cox regression analysis.RESULTSSixty-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 48h or less (hazard ratio 1.87, 95% CI 1.29 to 2.70, P=0.001), resternotomy at more than 48h (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).CONCLUSIONPatients 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.