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BAV and Normal Life Expectancy

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ElectLive

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Jun 26, 2011
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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Well, I know I have seen, and many others here have probably also, lots of outdated historical studies of valve patients with slightly scary long term survival rates.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. :)
 

Rachel

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Feb 1, 2012
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Holland, Michigan
Again, excellent post ElectLive!!!

So very grateful that you keep posting, I too have learned so much from you!!!!

Rachel
 

Roberta

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Feb 14, 2012
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Canada
Again, excellent post ElectLive!!!

So very grateful that you keep posting, I too have learned so much from you!!!!

Rachel
Elective,
I concur with Rachel. Thank you so much for your most informative and well researched posts. This most recent one helps put things in perspective. Also, appreciate you ongoing input. :)
 

ElectLive

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Jun 26, 2011
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Atlanta, GA
Thanks for the kind words Rachel and Roberta. This reminds me...I forgot to make an important point in my post here yesterday:

I realize that these studies may not seem quite as helpful for our younger members, since it's probably not the 10 to 20 year results that are most worrisome, it's the 20 to 30 years after that which cause more concern, yet are equally important if you are young. Well, of course, there is a big problem with finding relevant 50 year evidence: valve replacement was a different world 50 years ago, only in infancy, everything much higher risk than today. Case in point, the mortality rate for AVR was anywhere from 25% - 50% back in the 60's, around 6% - 11% in the 70's, and then finally reaching a more stable (but still improving, even today) level in the 80's of around 2% - 5%. So, anyway, just wanted to point out that unfortunately you "kids" in your 20s are going to need to wait awhile before getting useful long term evidence.
 

epstns

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EL - What makes you think that only the younger members are interested in the 20 to 30 year outcomes? I was 63 when my valve was replaced, and I would still be interested in the 20 to 30 year statistics!

Great information for all of us, and it should reassure many who have their doubts. Thank you very much for finding the information and posting it.
 

ElectLive

Well-known member
Joined
Jun 26, 2011
Messages
631
Location
Atlanta, GA
EL - What makes you think that only the younger members are interested in the 20 to 30 year outcomes? I was 63 when my valve was replaced, and I would still be interested in the 20 to 30 year statistics!
Steve - I think you may have misread or misunderstood my post (certainly a possibility at your age :biggrin2: ha ha). I actually said the 20 to 30 years after that (the first 20 years). But, in any case, you are correct, still no less important in evaluating your prospects for making it to 113! :thumbup:
 
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