ElectLive
Well-known member
Life expectancy questions seem to come up fairly often here, including a few recent threads, so I thought it would be good to add some contemporary research and evidence to the discussion. While the information here is strictly focused on those with Bicuspid Aortic Valve (since it's the most common valve disorder, it seems to also be the most studied), I think much of the evidence would reasonably translate to other valve disorders, so conclusions are somewhat universal.
Now, the natural assumption of most anyone would probably be that any person of any age with a valve problem will inevitably have a reduced lifespan. There's lots of obvious evidence to support this, the inherent risks we all face, really no need to explain further. On the other hand, we are all monitored by doctors to a much higher degree than our friends and likely have a greater interest in taking care of our own health, too.
Well, I know I have seen, and many others here have probably also, lots of outdated historical studies of valve patients with slightly scary long term survival rates. So today, I'd like to post instead two very recent studies (2008) from two of the most well regarded heart centers in the US (Mayo Clinic) and Canada (Toronto General). Both are studies of strictly BAV patients at varying degrees of valve dysfunction, in other words basically a population matched study. The Mayo study was enrolled between 1980 and 1999 with follow-up to 20 years. The Toronto General study was enrolled between 1994 and 2001 with mean follow-up of 10 years. Here are both the highlights and links to the full publication:
Mayo - http://circ.ahajournals.org/content/117/21/2776.full.pdf
"Survival was 97 +/- 1% and 90 +/-3% at 10 and 20 years [respectively] after diagnosis and was identical to expected survival of the population matched for age and sex...Observed versus expected survival comparison stratified by age at diagnosis showed no excess mortality in the 20-year, 20- to 49-year, and 50-year age groups."
Toronto General - http://jama.jamanetwork.com/article.aspx?volume=300&issue=11&page=1317
During the mean follow-up duration of 9 years, survival rates were not lower than for the general population. The 5-year mean survival was 97% (1%) in both the bicuspid aortic valve group and in the population estimates. The 10-year survival was similar in both the bicuspid aortic valve group (96% [1%]) and in the population estimates (97% [1%])...Prior series examining outcomes in patients with bicuspid aortic valve reported high rates of mortality and serious complications relating to endocarditis, cardiac surgery, heart failure, and dissection. Although a high frequency of cardiac events [translation - surgery] was observed in our cohort, serious cardiac morbidity and mortality was infrequent. Outcome differences between present and prior studies can be attributed to differences in the era that patients were examined, the population that was examined, the frequency of cardiac events associated with high mortality (aortic dissection and endocarditis), and advances in perioperative management...The generalizability of our study results is reinforced by the similarity in the findings reported in the Olmsted County [Mayo Clinic] study, despite differences in the era from which the study population was identified (1980-1999 for Olmsted vs 1996-2001 in our study), duration of follow-up, and origin of the patient population (community-based vs hospital-based)."
So, there you have it. Yes, all studies have limitations. But, I tell you what, this is about as good as it gets in terms of sound, relevant, and encouraging evidence. Oh, and if any other questions about long term prospects, Dick (dick0236) of course is here everyday to prove it.
Now, the natural assumption of most anyone would probably be that any person of any age with a valve problem will inevitably have a reduced lifespan. There's lots of obvious evidence to support this, the inherent risks we all face, really no need to explain further. On the other hand, we are all monitored by doctors to a much higher degree than our friends and likely have a greater interest in taking care of our own health, too.
Well, I know I have seen, and many others here have probably also, lots of outdated historical studies of valve patients with slightly scary long term survival rates. So today, I'd like to post instead two very recent studies (2008) from two of the most well regarded heart centers in the US (Mayo Clinic) and Canada (Toronto General). Both are studies of strictly BAV patients at varying degrees of valve dysfunction, in other words basically a population matched study. The Mayo study was enrolled between 1980 and 1999 with follow-up to 20 years. The Toronto General study was enrolled between 1994 and 2001 with mean follow-up of 10 years. Here are both the highlights and links to the full publication:
Mayo - http://circ.ahajournals.org/content/117/21/2776.full.pdf
"Survival was 97 +/- 1% and 90 +/-3% at 10 and 20 years [respectively] after diagnosis and was identical to expected survival of the population matched for age and sex...Observed versus expected survival comparison stratified by age at diagnosis showed no excess mortality in the 20-year, 20- to 49-year, and 50-year age groups."
Toronto General - http://jama.jamanetwork.com/article.aspx?volume=300&issue=11&page=1317
During the mean follow-up duration of 9 years, survival rates were not lower than for the general population. The 5-year mean survival was 97% (1%) in both the bicuspid aortic valve group and in the population estimates. The 10-year survival was similar in both the bicuspid aortic valve group (96% [1%]) and in the population estimates (97% [1%])...Prior series examining outcomes in patients with bicuspid aortic valve reported high rates of mortality and serious complications relating to endocarditis, cardiac surgery, heart failure, and dissection. Although a high frequency of cardiac events [translation - surgery] was observed in our cohort, serious cardiac morbidity and mortality was infrequent. Outcome differences between present and prior studies can be attributed to differences in the era that patients were examined, the population that was examined, the frequency of cardiac events associated with high mortality (aortic dissection and endocarditis), and advances in perioperative management...The generalizability of our study results is reinforced by the similarity in the findings reported in the Olmsted County [Mayo Clinic] study, despite differences in the era from which the study population was identified (1980-1999 for Olmsted vs 1996-2001 in our study), duration of follow-up, and origin of the patient population (community-based vs hospital-based)."
So, there you have it. Yes, all studies have limitations. But, I tell you what, this is about as good as it gets in terms of sound, relevant, and encouraging evidence. Oh, and if any other questions about long term prospects, Dick (dick0236) of course is here everyday to prove it.
