PMID- 9030794
OWN - NLM
STAT- MEDLINE
DCOM- 19970507
LR  - 20190512
IS  - 1010-7940 (Print)
IS  - 1010-7940 (Linking)
VI  - 11
IP  - 1
DP  - 1997 Jan
TI  - Long-term relative survival after primary heart valve replacement.
PG  - 81-91
AB  - OBJECTIVE: Determination of the optimal timing of primary heart valve replacement 
      is an important issue. The present paper provides a synopsis over early and late 
      survival after primary heart valve replacement, including an evaluation of the 
      excess mortality among heart valve replacement patients compared with the general 
      population. METHODS: Survival was analyzed in 2365 patients (1568 without and 797 
      with concomitant coronary artery bypass grafting (CABG)) who underwent their 
      first heart valve replacement. Observed survival was related to that expected 
      among persons from the general Swedish population stratified by age, sex, and 
      5-year calendar period, to calculate the relative survival and estimate the 
      disease-specific survival. RESULTS: Early mortality (death within 30 days after 
      surgery) was 5.9% after aortic valve replacement, 10.4% after mitral valve 
      replacement and 10.6% after combined aortic and mitral valve replacement. 
      Relative survival rates (excluding early deaths) were 84% 10 years after aortic, 
      68.5% after mitral and 80.9% after both aortic and mitral valve replacement. A 
      multivariate model based on observed survival rates was produced for each group, 
      using the Cox proportional hazards model. Concomitant CABG, advanced New York 
      Heart Association (NYHA) class, preoperative atrial fibrillation, pure aortic 
      regurgitation and higher age increased the late observed survival after aortic 
      valve replacement. NYHA class was the only factor independently related to 
      observed late deaths after mitral valve replacement, and mitral insufficiency the 
      only corresponding factor after both aortic and mitral valve surgery. CONCLUSION: 
      The use of relative survival rates tended to modify the difference between 
      subgroups compared with observed survival rates. Relative survival rates reduced 
      the effect of concomitant CABG on survival, but enhanced for example the effect 
      of aortic regurgitation. In patients > or = 70 years of age and patients 
      submitted to aortic or mitral valve replacement with mild or no symptoms, the 
      survival rate was similar for many years to that in the Swedish population at 
      large.
FAU - Stahle, E
AU  - Stahle E
AD  - Department of Thoracic and Cardiovascular Surgery, University Hospital, Uppsala, 
      Sweden.
FAU - Kvidal, P
AU  - Kvidal P
FAU - Nystrom, S O
AU  - Nystrom SO
FAU - Bergstrom, R
AU  - Bergstrom R
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - Germany
TA  - Eur J Cardiothorac Surg
JT  - European journal of cardio-thoracic surgery : official journal of the European 
      Association for Cardio-thoracic Surgery
JID - 8804069
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Aortic Valve/surgery
MH  - Bioprosthesis/*mortality
MH  - Combined Modality Therapy
MH  - Coronary Artery Bypass/mortality
MH  - Coronary Disease/mortality/surgery
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Valve Diseases/mortality/*surgery
MH  - Heart Valve Prosthesis/*mortality
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Mitral Valve/surgery
MH  - Postoperative Complications/*mortality
MH  - Proportional Hazards Models
MH  - Prosthesis Design
MH  - Registries/statistics & numerical data
MH  - Survival Analysis
MH  - Sweden/epidemiology
MH  - Treatment Outcome
EDAT- 1997/01/01 00:00
MHDA- 1997/01/01 00:01
CRDT- 1997/01/01 00:00
PHST- 1997/01/01 00:00 [pubmed]
PHST- 1997/01/01 00:01 [medline]
PHST- 1997/01/01 00:00 [entrez]
AID - S1010794096010251 [pii]
AID - 10.1016/s1010-7940(96)01025-1 [doi]
PST - ppublish
SO  - Eur J Cardiothorac Surg. 1997 Jan;11(1):81-91. doi: 
      10.1016/s1010-7940(96)01025-1.