Relative survival after SAVR for aortic stenosis was 83.3% at 10 years, with impaired LV ejection fraction, MR, Indigenous status, diabetes, and renal impairment doubling excess mortality risk.
Does surgical aortic valve replacement restore normal life expectancy in patients with significant aortic stenosis compared to a matched general population?
Relative survival following SAVR for significant aortic stenosis remains reduced compared to the general population, with excess mortality driven by baseline comorbidities and cardiac damage such as impaired LVEF and significant mitral regurgitation.
Abstract Background Surgical aortic valve replacement (SAVR) improves survival in severe, symptomatic aortic stenosis (AS), but whether it fully restores life expectancy is uncertain. Prior studies suggest persistent excess mortality in some patients, but the underlying determinants remain poorly defined. Purpose To evaluate long-term relative survival following SAVR compared to an age-, sex-, and year-matched general population, determine whether post-AVR excess mortality converges or persists over time, and identify predictors of any residual survival discrepancies. Methods A total of 1,287 patients (median age 71 63–77 years, 32% female) undergoing SAVR for significant (≥moderate) AS between January 2010 and December 2020 were identified from the Western Autralian Heart Valves Study (WAVES) database. Flexible parametric models were used to estimate relative survival. Results Over a median follow-up of 47 (23 to 81) months, 247 (19%) patients died. All-cause 30-day, 1-year, 5-year, and 10-year relative survival rates were 97.3%, 97.2%, 93.0% and 83.3%, respectively, compared to matched national mortality (Figure 1). Survival modelling revealed a non-linear hazard over time, characterized by distinct early and late phases of risk (Figure 2). Multivariable modelling indicated impaired left ventricular (LV) ejection fraction (45 to 60%, excess HR 1.97, 95% CI 1.11 to 3.51, P=0.02; 30 to 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=0.0002), diabetes mellitus (excess HR 2.30, 95% CI 1.44 to 3.68, P=0.0005), estimated glomerular filtration rate (eGFR) 30 to 59 ml/kg/1.73m² (excess HR 2.74, 95% CI 1.33 to 5.65, P=0.006) and eGFR 0 to 29 ml/kg/1.73m² (excess HR 5.75, 95% CI 2.36 to 13.99, P=0.0001) 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 to age-, sex-, and year-matched national mortality data, with excess death persisting and escalating after the first postoperative year. Impaired LV ejection fraction, significant MR, Indigenous status, renal impairment, and diabetes mellitus were independent predictors of long-term excess mortality. Timely intervention and optimized post-operative follow-up may be crucial for the restoration of normal life expectancy following SAVR.Figure 1:Observed Vs Expected Survival Figure 2:HR vs Matched Population
Butcher et al. (2025) studied this question. Relative survival after SAVR for aortic stenosis was 83.3% at 10 years, with impaired LV ejection fraction, MR, Indigenous status, diabetes, and renal impairment doubling excess mortality risk.