Monday, April 15, 2024

Heart Valve Replacement Surgery Survival Rate

Length Of Stay And Rehospitalization

Safety & Mortality Rates of Aortic Valve Replacement (with Dr. Patrick McCarthy)

The overall 1-year readmission rate of 44% is congruent with other studies . In a cohort of patients with a mean age of 82years, TAVR patients were reported to have a readmission rate of 43% . Despite much focus on the advantages and shorter rehabilitation after TAVR procedures, data addressing this topic are scarce. High readmission rates are observed in both SAVR and TAVR , underscoring the need for prophylactic tools and rehabilitation. Murugiah et al. documented an age-related reduction in the index LOS and a declining rate of readmission over a 10-year period after SAVR.

Cardiac Surgery In The Very Elderly: It Isnt All About Survival

Post-CCT Clinical Fellow in Cardiac Surgery

Simon Kendall Consultant Cardiac Surgeon and President Elect SCTS

Department of Cardiothoracic Surgery, James Cook University Hospital, Marton Road, Middlesborough, TS4 3BW

Correspondence to:

Cardiac surgery for adults became widely available around 50 years ago, due mainly to the introduction of relatively safe cardiopulmonary bypass. Initially, mortality rates were quite high, even for relatively young and fit patients, and, therefore, patients and carers focused on this outcome measure. Moreover, it was easy to define and record. Local and national registries developed into databases that allowed comparison of mortality rates and were then further refined with risk modelling.

As the odds of survival after cardiac surgery improved, sicker and older patients were offered cardiac surgery, including octogenarians and extending to nonagenarians.

Clearly, surviving cardiac surgery is very important but is survival the top priority for the 92-year old after bypass surgery who becomes unable to live independently again and whos quality of life is insufferable? Should quality of life be the main factor driving therapeutic decisions for the frail and elderly?

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Symptoms Of Aortic Valve Disease

Sometimes, if you have a problem with your aortic valve, you may not experience any symptoms until later on in the disease process. Any symptoms you feel occur because your heart cannot pump blood around your body efficiently. Symptoms you may have include:

  • chest pain brought on by physical activity this is caused by your heart having to work harder due to restricted blood flow through your aortic valve
  • shortness of breath at first you may notice this only when you exercise, but later you may experience this even when resting
  • dizziness or light-headedness this is caused by the obstruction of the flow of blood from your heart to the rest of your body
  • loss of consciousness this is also a result of reduced blood flow caused by the obstruction in your heart

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When Is It Necessary To Replace The Aortic Valve

The aortic valve may need to be replaced for 2 reasons:

  • the valve has become narrowed the opening of the valve becomes smaller, obstructing the flow of blood out of the heart
  • the valve is leaky the valve allows blood to flow back through into the heart

The problems can get worse over time and in severe cases can lead to life-threatening problems such as heart failure if left untreated.

There are no medicines to treat aortic valve problems, so replacing the valve will be recommended if you’re at risk of serious complications but are otherwise well enough to have surgery.

What To Expect Afterward

Survival of Transcatheter Mitral Valve Repair Compared With Surgical ...

After open-heart surgery, a person will wake up in the ICU and remain there for observation for up to 2 days. They will then go to the regular surgical unit for up to 5 days.

Recovery generally takes several months. The speed of a persons recovery may depend on several factors, including their general health and age.

While it is usually safe to resume typical activities not long after surgery, a doctor will likely advise a person to avoid high intensity activities and take several weeks off from work.

It is typical to experience weakness and fatigue after this invasive surgical procedure. Most people will find that they regain their strength as they resume daily physical activities.

Most valve replacement procedures are successful. However, people may need to have valves replaced again in the future.

According to a 2021 Swedish study involving 33,018 people who underwent aortic valve replacement surgery, people who had this type of surgical procedure had a lower life expectancy than the general population. However, not all those who died within the follow-up period died as a result of heart problems.

In 2019, published in the Journal of Cardiothoracic Surgery, involving 324 people who underwent mitral valve replacement, found that:

  • 1.9% of people died during the procedure
  • 9% of people died after 30 days
  • people who received a biological valve had a survival rate of 62.4% at 10 years
  • people who received a mechanical valve had a survival rate of 77.1% at 10 years

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How Long Does It Take To Recover

Open heart surgery requires 57 days of hospital stay, while home care continues for 710 days afterward. Minimally invasive procedures generally require less time in the hospital and have quicker recovery periods. However, recovery after a sternotomy, a surgical incision through the sternum, can take several weeks or months.

A range of factors, such as age and other health conditions, can influence healing. A persons doctor will provide guidance on recovery time.

Heart Surgery Survival Rates By Type Of Procedure

The Cardiac Center team performs more than 850 pediatric heart surgeries a year, including open heart and closed heart procedures and heart transplants. Open heart procedures, which represent a major portion of our volume, require cardiopulmonary bypass and are usually the most complicated and complex procedures.

Pediatric heart surgery survival rates reflect the number of patients who survived within 30 days of the surgery or until the time they were discharged, whichever period is longer.

We track outcomes from common procedures as Quality Indicators for congenital heart surgery. The following data shows CHOPâs outcomes for these procedures.

The cardiac surgery indicators are included in the Society of Thoracic Surgeons Congenital Heart Surgery Database and in the National Quality Forum standards for pediatric heart surgery. The STS Congenital Heart Surgery Database contains data from over 100 congenital heart surgery centers in North America. The NQF is a nonprofit organization that sets or endorses standards to measure quality in healthcare.

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Open Heart Surgery Survival Rates

Heart surgery programs typically report their overall survival rate as well as survival rates based on the complexity of the surgery.

What we measure:

The percentage of heart surgery patients who survive their open heart surgery.

At Childrens Colorado, our overall survival rate for all cardiac surgery patients, regardless of how complex the surgeries are, is 97.2%. This is the same as the national average.

What it means:

Having a higher survival rate indicates that a pediatric heart center is more experienced and better equipped for congenital heart surgery, and that fewer patients pass away during or after surgery.

Some heart centers take more complicated cases than others, which is why its important to also compare survival rates by complexity and type of defect.

Outcomes After Avr In Patients Aged 80 And More

What is transcatheter aortic valve replacement (TAVR)?

There are studies reporting good outcomes after AVR in the elderly. Gehlot et al. studied 322 patients with a mean age of 82.2 years who underwent AVR. On multivariate analysis, the most important independent predictors of mortality included female gender, renal impairment, EF 35%, bypass grafting and chronic obstructive pulmonary disease. Age and year of operation did not influence mortality. Five-year survival rates for all patients and for operative survivors were 60.2 ± 3.2% and 70.3 ± 3.4%. Asimakopoulos et al. reported on data collected from 1100 patients > 80 years undergoing AVR from the UK Heart Valve Registry. Actuarial survival rates were 89, 79, 69% and 46% at 1, 3, 5 and 8 years, respectively. Survival in the operated patients in our series was practically identical to this. Sundt et al. retrospectively evaluated 133 patients between the age of 80 and 91 years undergoing AVR. Actuarial survival rates at 1 and 5 years were 80 and 55%, respectively. Urgent or emergent surgery, aortic insufficiency, perioperative stroke or renal dysfunction were significant risk factors for operative death by multivariate analysis.

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Alternatives To An Aortic Valve Replacement

An aortic valve replacement is the most effective treatment for aortic valve conditions.

Alternative procedures are usually only used if open heart surgery is too risky.

Possible alternatives include:

  • transcatheter aortic valve implantation the replacement valve is guided into place through the blood vessels, rather than through a large incision in the chest
  • aortic valve balloon valvuloplasty the valve is widened using a balloon
  • sutureless aortic valve replacement the valve is not secured using stitches to minimise the time spent on a heart-lung machine

Page last reviewed: 23 December 2021 Next review due: 23 December 2024

Myth: Heart Valve Surgery Decreases Patient Life Expectancy

The truth: Not necessarily, said Dr. Gerdisch. Several medical studies came to this conclusion, estimating that the life expectancy a patient having valve surgery would be shortened by one to four years. Without surgery at all, however, a patients survival rate is only a few years.

The most important determinant of how heart valve surgery affects life expectancy is the time of surgery. It is most important that heart disease is monitored well before there is irreparable damage to the heart, said Dr. Gerdisch.

Whats more, if a patients valve can be repaired instead of replaced, the concern about a shortened life expectancy disappears.

Every replacement poses some risk for the patient because introduces a foreign object into the body. But when we repair a valve with the patients own tissue, we eliminate that risk of rejection and restore life expectancy to normal, said Dr. Gerdisch.

In addition to expanded surgery options for heart valve replacement and repair, heart specialists now have interventional choices to treat heart valve disease, including transcatheter aortic valve replacement, or TAVR. This valve replacement can be delivered via a catheter and doesnt require open-heart surgery. When first used, it was an excellent choice for patients who were not good candidates for more invasive surgery, especially if they had symptoms of heart failure.

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How Long Does It Take To Recover From Heart Valve Surgery

Open heart surgery typically requires a person to stay 57 days in the hospital, with home care continuing for 710 days. During this time, someone will likely require assistance with everyday tasks. It takes between 6 and 12 weeks for the breastbone to heal completely, but it can take longer.

If a person has a valvuloplasty or TAVI, the recovery time will be shorter.

Gradually, these individuals can return to everyday activities such as driving, walking, exercising, and working. However, people should follow the advice of their doctor and not rush the recovery period.

Common side effects of the operation are:

  • pain and discomfort

Although each persons experience will differ, the following are the basics of what to expect during and after the surgery.

How Is A Heart Valve Replacement Surgery Performed

Trans catheter aortic valve implantation (TAVI)

Heart valve replacement surgery can be performed via any of the two approaches:

  • Open-heart surgery: Traditional method of heart surgery in which a large incision is made in the chest the heart is stopped for a time so that the surgeon can repair or replace the valve.
  • Minimally invasive heart surgery: These are the newer techniques in which the doctors make smaller incisions over the chest to replace the heart valves.

The diseased valves may be replaced by any of the artificial valves that include:

  • Manufactured mechanical valve: Made up of carbon-coated plastic, the mechanical valve is the most durable type of valve that will usually last for your entire lifetime.
  • Donors valve: This is an actual human valve taken from a donor and implanted in your heart . It usually lasts for anywhere between 10 to 20 years.
  • Tissue valve: Created from animal valves or tissues, this type of heart valve is expected to stay healthy for 10 to 20 years after the surgery.

Your doctor will discuss the benefits and risks of the available surgical options as well as of the types of valves.

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How Surgery Is Performed

An aortic valve replacement is carried out under general anaesthetic. This means you will be asleep during the operation and will feel no pain.

The surgeon will begin the operation by making a large incision down the centre of your breastbone . The incision will be around 25cm long. This is known as a sternotomy and it allows the surgeon access to your heart.

Survival Rate Of Heart Valve Replacement Surgery

  • Related Resources – Survival Rate of Heart Valve Replacement Surgery
  • The survival rate for a heart valve replacement surgery depends on which valve is involved. This was analyzed in a large study in which the lifespan of a large population, who went ahead with the surgery, is observed for a specific timeframe.

    The 5-year survival rate means what percentage of people lived for at least 5 years after the surgery. Similarly, the 10-year survival rate means what percentage of people lived for at least 10 years after the surgery.

    For example, the 5-year survival rates for aortic valve replacement surgery is 94%. This means 94 out of 100 people who underwent AVR surgery could live at least 5 years.

    Table 1: The Survival Rates as Per the Type of Valve in Heart Valve Replacement Surgeries

    Survival rates for heart valve replacement surgery are often used as predictors of how long patients can live beyond a certain number of years after the surgery. However, these may vary for you depending on your age, your overall health, and the current status of your heart function. Discuss with your doctor about these factors to know about your life expectancy after the surgery.

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    Myth: Mechanical Valves Are Not As Good As Tissue Valves

    The truth: Not so, says , medical director of cardiothoracic surgery at Franciscan Health Indianapolis.

    Tissue or bioprosthetic valves, usually made with porcine products, have made a lot of news in recent years. Benefits include less dependency on powerful blood thinners than mechanical valves, which makes them a good choice if a patient has issues with these medications. On the other hand, mechanical valves have been around a long time, and tissue valves can deteriorate due to calcium buildup or advancing heart disease and eventually need replacing.

    Still, the final choice on whether to use mechanical or tissue valves to replace heart valves should take into account several factors, according to Dr. Gerdisch.

    The choice of tissue or mechanical valve should be tailored to the individual patient, based on age, lifestyle, other medical conditions and the patients expectations, he said.

    Several studies have demonstrated no difference between mechanical and tissue valves in patient survival, Dr. Gerdisch said. All the valves are on the shelfI can put in a mechanical valve I can put in a tissue valve. We just need to decide, through several individual factors, which choice will be right for each patient.

    Other Frequently Asked Questions

    Life Expectancy & Heart Valve Surgery: Patient Insights with Dr. Joanna Chikwe
    • Is there such a thing as too old? What about aortic valve replacement in a 90-year-old? Ultimately, theres two people who matter when making this decision: the senior and their doctor. There are risks associated with any medical procedure, but you may decide that the cost of inaction outweighs the risks.
    • If I had heart valve replacement at 65, will I need another later? Possibly, depending on a number of factors, including the health of your other valves at the time. Its not uncommon for those with heart valve issues to live long lives with the help of modern medicine, nutrition and fitness.

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    Pediatric Heart Surgery Volumes

    Finally, when it comes to congenital heart surgery, volume matters. Studies show that kids who need heart surgery do better when they are treated by medical teams that perform a high number of surgeries. This is because surgeons in high-volume centers get more experience and see a wider range of heart defects than surgeons who perform only a handful of surgeries per year.

    Performing hundreds of surgeries each year indicates that the hospital is a high-volume center and is likely to have better patient outcomes. This is particularly true for patients with complex heart defects.

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    Surgical Replacement Of Aortic Valves Offers Good Long

    This is a plain English summary of an original research article

    People undergoing surgery to replace a narrowed aortic heart valve have only slightly lower life expectancy than people without the condition. Surgery was also associated with a low rate of stroke.

    This review gathered data from 93 observational studies that followed long term outcomes for people with severe aortic stenosis who had the valve replaced with a biological or tissue valve.

    Following surgery, survival ranged from 16 years on average for people aged 65 or less, to six or seven years for those over 75. Fewer than one in 100 developed a stroke each year.

    Ten years after surgery most people still had a good functioning valve. By 20 years the rate of valve deterioration had risen to 48%.

    Bioprosthetic valves appear safe and are linked to average lifespan for this population, but there may be a need for monitoring and possible replacement after the first ten years.

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