Patients who undergo surgical aortic valve replacement (SAVR) have a lower-than-normal life expectancy, according to new findings published in the Journal of the American Heart Association. What can clinicians do to combat this trend?
“According to current guidelines, only symptomatic patients, or those with reduced left ventricular function secondary to their aortic valve disease, have a class I indication for surgery,” wrote lead author Natalie Glaser, MD, PhD, a cardiologist at Stockholm South General Hospital in Sweden, and colleagues. “However, recent studies showed that asymptomatic patients may benefit from early surgery, and the optimal timing for aortic valve replacement has been debated. Severe valve disease results in gradual and irreversible myocardial damage. Valve replacement before occurrence of symptoms and myocardial injury may improve long‐term outcomes.”
Glaser et al. tracked data from more than 33,000 SAVR patients treated in Sweden from 1997 and 2018. The mean patient age was 68.9 years old, and 63% were men.
After a mean follow-up period of 7.3 years, 43% of patients had died. The authors calculated standardized mortality ratios for cardiovascular-related deaths (1.79), cancer-related deaths (1.00) and other causes of death (1.08).
“In other words, the relative risks of cardiovascular and other causes of death were significantly higher in patients who underwent SAVR than in the general population,” they explained.
The group also noted that cardiovascular death was more likely among younger SAVR patients—and among those younger patients, that risk was greater among women than men. In addition, mechanical valve prostheses were associated with a higher risk of cardiovascular death than biological valve prostheses.
“The risk of death from cardiovascular causes was almost twice as high after undergoing aortic valve replacement compared with the reference population and explains the reduced life expectancy observed following aortic valve replacement,” the authors wrote. “Prosthetic aortic valves pose an inevitable risk of complications, both over the short and long term, although our results also raise questions concerning the optimal timing of surgery in patients with aortic valve disease.”
For example, they continued, should patients be undergoing SAVR earlier? More research is needed in that area, the group wrote, but it is certainly a key point to consider. Also, “poor guideline implementation,” “failure to integrate new knowledge into clinical practice” and “suboptimal postoperative follow-up” were all listed as potential explanations for these higher risks among SAVR patients.
“Future studies should focus on the role of earlier surgery in patients with asymptomatic aortic stenosis and optimizing treatment and follow‐up after aortic valve replacement,” the authors concluded.
The full study is available here.
Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.