New knowledge on life expectancy after aortic valve replacement
Patients who have undergone surgical replacement of the heart’s aortic valve have a shorter life expectancy than the normal population, the loss in life expectancy being particularly marked in the young. This according to a registry study published in The Journal of the American College of Cardiology by researchers at Karolinska Institutet in Sweden.
Some 1,500 patients undergo the surgical replacement of an aortic valve every year in Sweden.
To obtain a better understanding of the patients’ prognosis after surgery, researchers at Karolinska Institutet have conducted a national study comparing post-operation survival with life expectancy of the normal population.
The results, which are published in The Journal of the American College of Cardiology (JACC), show that the patients who have had their aortic valve surgically replaced have a shorter life expectancy than the normal population.
“The loss in life expectancy is greatest in younger patients, which presumably is because younger people have a longer life expectancy than older people,” says the study’s first author Natalie Glaser, doctor and researcher at the Department of Molecular Medicine and Surgery at Karolinska Institutet.
In people who have undergone surgery to replace the aortic valve before the age of 50, the loss in life expectancy was 4.4 years compared to the normal population. For aortic valve-replacement patients in general, this loss was 1.9 years. Without treatment, however, the mean survival for these patients is two to three years.
The researchers found no differences in loss of life expectancy between women and men.
The study included over 23,000 patients who had undergone surgical replacement of the aortic valve in Sweden between the years 1995 and 2013, gathered through the national SWEDEHEART register. Survival data were sourced from the cause of death registry and data on life expectancy in the normal Swedish population from the Human Mortality Database.
Operated patients were compared with people from the normal population matched by age, sex and year of operation.
The results of the study provide a measure of the disease burden after aortic valve replacement in society but are also of potential use to both patients and healthcare professionals, says Dr Glaser.
“We can now inform patients more effectively about the long-term post-surgical prognosis,” she continues. “We might be able to tailor both pre- and post-surgical treatment better by, for example, taking care of risk factors and monitoring certain patients more closely for a longer time.”
Further work needs to be done to examine the reason for the shorter life-expectancy after surgery.
The study was financed with grants from the Swedish Heart and Lung Foundation, the Mats Kleberg Foundation, Karolinska Institutet’s Foundations and Funds, the Åke Wiberg Foundation, the Magnus Bergvall Foundation, the ALF programme with Region Stockholm and a donation from Fredrik Lundberg. One of the authors has declared the receipt of consultancy fees from the companies Actelion, Idorsia and Pfizer.
“Loss in life expectancy after surgical aortic valve replacement: SWEDEHEART observational study”.
Natalie Glaser, Michael Persson, Veronica Jackson, Martin J Holzmann, Anders Franco-Cereceda, Ulrik Sartipy.
Journal of the American College of Cardiology, online 1 July 2019.