{
  "abstract": "Aim Surgical aortic valve replacement (SAVR) improves survival in severe, symptomatic aortic stenosis (AS), but whether it fully restores life expectancy is uncertain. This study aimed to evaluate long-term relative survival following SAVR compared with the general population and identify predictors of any residual survival discrepancies.Method A total of 1287 patients (median age 71 (63–77) years, 32% female) undergoing SAVR for ≥moderate AS were identified from the Western Australian Heart Valves Study database. Flexible parametric models were used to estimate relative survival.Results Over a median follow-up of 47 (23–81) months, 247 (19%) patients died. All‐cause 30‐day, 1‐year, 5‐year and 10-year relative survivals were 97.3%, 97.2%, 93.0% and 83.3%, respectively, compared with an age-matched, sex-matched and year-matched general population. Flexible multivariable modelling indicated impaired left ventricular ejection fraction (LVEF) (45%–60%, excess HR 1.97, 95% CI 1.11 to 3.51, p=0.02; 30%–45%, excess HR 2.40, 95% CI 1.24 to 4.64, p=0.01; <30%, excess HR 2.96, 95% CI 1.18 to 7.39, p=0.02), significant mitral regurgitation (MR) (excess HR 2.28, 95% CI 1.29 to 4.03, p=0.005), Indigenous status (excess HR 4.53, 95% CI 2.03 to 10.12, p<0.001), diabetes mellitus (excess HR 2.30, 95% CI 1.44 to 3.68, p<0.001), estimated glomerular filtration rate (eGFR) 30–59 mL/kg/1.73 m 2 (excess HR 2.74, 95% CI 1.33 to 5.65, p=0.006) and eGFR 0–29 mL/kg/1.73 m2 (excess HR 5.75, 95% CI 2.36 to 13.99, p<0.001) were independently associated with long-term excess mortality relative to that of the national comparator, whereas age, sex, year of surgery, concomitant coronary artery bypass graft surgery and symptom status were not.Conclusion In a contemporary population, relative survival following SAVR for significant AS was reduced compared with an age-matched, sex-matched and year-matched general population. Impaired LVEF, significant MR, Indigenous status, renal impairment and diabetes mellitus were independent predictors of long-term excess mortality. Timely intervention and optimised postoperative follow-up may be crucial for the restoration of normal life expectancy following SAVR.",
  "authors": [
    {
      "affiliations": [
        "Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia",
        "Medical School, The University of Western Australia, Perth, Western Australia, Australia"
      ],
      "name": "Steele C Butcher"
    },
    {
      "affiliations": [
        "Department of Cardiology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia"
      ],
      "name": "Stephen Lewin"
    },
    {
      "affiliations": [
        "School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia",
        "Cardiovascular Epidemiology Research Centre, The University of Western Australia, Perth, Western Australia, Australia"
      ],
      "name": "Charley A Budgeon"
    },
    {
      "affiliations": [
        "Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia"
      ],
      "name": "Jarryd Walker"
    },
    {
      "affiliations": [
        "Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia",
        "Medical School, The University of Western Australia, Perth, Western Australia, Australia"
      ],
      "name": "William A Courtney"
    },
    {
      "affiliations": [
        "Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia"
      ],
      "name": "Primero Ng"
    },
    {
      "affiliations": [
        "School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia"
      ],
      "name": "Georgie Graham"
    },
    {
      "affiliations": [
        "School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia",
        "Cardiovascular Epidemiology Research Centre, The University of Western Australia, Perth, Western Australia, Australia"
      ],
      "name": "Frank M Sanfilippo"
    },
    {
      "affiliations": [
        "School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia"
      ],
      "name": "Luke J Waller"
    },
    {
      "affiliations": [
        "Department of Cardiology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia",
        "Medical School, Curtin University, Perth, Western Australia, Australia"
      ],
      "name": "Abdul Ihdayhid"
    },
    {
      "affiliations": [
        "Medical School, The University of Western Australia, Perth, Western Australia, Australia"
      ],
      "name": "Tom Gilbert"
    },
    {
      "affiliations": [
        "The University of Notre Dame Australia School of Medicine - Fremantle Campus, Fremantle, Western Australia, Australia",
        "Department of Cardiothoracic Surgery, Fiona Stanley Hospital, Murdoch, Western Australia, Australia"
      ],
      "name": "Jurgen Passage"
    },
    {
      "affiliations": [
        "Medical School, The University of Western Australia, Perth, Western Australia, Australia",
        "Department of Cardiothoracic Surgery, Fiona Stanley Hospital, Murdoch, Western Australia, Australia"
      ],
      "name": "J James Edelman"
    },
    {
      "affiliations": [
        "Department of Cardiology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia"
      ],
      "name": "James M Rankin"
    },
    {
      "affiliations": [
        "School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia",
        "Cardiovascular Epidemiology Research Centre, The University of Western Australia, Perth, Western Australia, Australia"
      ],
      "name": "Tom Briffa"
    },
    {
      "affiliations": [
        "Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia",
        "Medical School, The University of Western Australia, Perth, Western Australia, Australia"
      ],
      "name": "Graham S Hillis"
    }
  ],
  "title": "Life expectancy and determinants of relative survival following surgical aortic valve replacement for aortic stenosis",
  "uid": "ab6ed90d-20af-52ba-9eca-4d17c3fa1180"
}