Surgical aortic valve replacement (SAVR) is associated with high survival rates for a wide range of patients, according to new data published in the Journal of the American College of Cardiology.
Researchers examined 8,353 patients who underwent isolated biological aortic valve replacement (B-AVR) between 2012 and 2017. Forty-eight percent of the patients were women, and the mean patient age was 75 years old. Data came from the Swedish Cardiac Surgery Register.
All patients were 60 years old or older and presented with aortic stenosis. SAVR or transcatheter aortic valve replacement (TAVR) could be potential treatment options for all participants.
Researchers used EuroSCORE (2001-2011) or EuroSCORE II (2012-2017) risk scores to divide the patients into different groups based on their surgical risk. The study included 85.1% low-risk patients, 11.3% intermediate-risk patients and 3.5% high-risk patients.
“Life expectancy after SAVR in relation to age, both in absolute numbers and in relation to the general population, has been thoroughly reported,” wrote lead author, Andreas Martinsson, MD, PhD, with the department of cardiology at Sahlgrenska University Hospital in Sweden. “By contrast, life expectancy in relation to surgical risk and surgical risk combined with chronological age has not previously been published, despite the strong recommendations for assessing these factors during the heart team’s decision-making process.”
A key finding from the team’s analysis was that low-risk patients had a median survival time of 10.9 years. The median survival time was 7.3 years for intermediate-risk patients and 5.8 years for high-risk patients. Also, the cumulative five-year mortality for each group was 16.5% for low-risk patients, 30.7% for intermediate-risk patients and 43% for high-risk patients.
Among low-risk patients, the median survival time ranged from 16.2 years in patients aged 60 to 64 years old to 6.1 years in patients aged 85 years old or older.
The cumulative five-year mortality of low-risk patients ranged from 6.8% in patients aged 60 to 64 years old to 37.7% in patients aged 85 years old or older.
The authors also noted that the association between age and mortality risk was substantially different between risk groups.
For example, in low-risk patients, there was a considerable link between higher age at surgery and five-year mortality. However, there was no significant association between age and mortality observed in intermediate- or high-risk patients.
Overall, the team concluded, SAVR continues to be associated with strong patient outcomes.
"Estimated survival is substantial following SAVR, especially in younger, low-risk patients, which should be considered in hart team discussions," they wrote.
Read the full study here.