Life Expectancy BAV Mechanical vs Tissue

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Bmorgan4

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Apr 16, 2021
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Interesting for certain. I had my BAV surgery 4 years ago at 50. Life expectancy was 80, although I tried to contractually "lock that in" my doctors could not do so. Stay healthy, trim and get your sleep was the main advice. The "event risk" of valve replacement (hopefully TAVI procedure) likely to cause a spike (or 2), but hope to be trolling the planet for a long time. They estimate 107bln people have lived on planet Earth and 7.9bln of those are currently alive due to > life expectancy (-200mm due to wars in 20th century, -500mm Smallpox, -170mm genocide). JCG
What valve did you choose at age 50?
 

cldlhd

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digging around this article I would suggest that where they say


... The life expectancy of individuals with asymptomatic BAV who are identified in the community is excellent and similar to that of the general population.7 8 However, patients who undergo surgical aortic valve replacement (AVR) have a life expectancy that is approximately 2 years shorter than that of the general population.9 Furthermore, the prognosis of patients with BAV versus the general population after aortic valve surgery remains to be determined.​

that this is related to the very small number of complications that arise from surgery, discounting those issues I would not be surprised to find that its "similar to that of the general population" (and what the fcuk is 1.9 years if not similar)

points to note:
The mean follow-up period was 6.3 years (maximum 13.3 years)​

not much really, not even lenghty with many studies follwing up 10 years (and the study I was involved in 29 years).

ultimately they say themselves:
Conclusions The survival of patients with BAV following aortic valve surgery was excellent and similar to that of the general population.​
So I was wondering about this myself. I didn't read the stats or the article yet but I would imagine that if you had just a small percentage of people die shortly after surgery due to surgical complications that would skew the numbers a good bit. I still have my original BAV, my surgeon threw a few stitches in it and tuned it up back in February 2015 ( can't believe it's been that long..) and I had my aortic aneurysm replaced. He said the valve was in really good shape with good flow ( pressure gradients) and very little leakage. FWIW He seems to think I should have a normal life span as in if I take good care of myself I'll live longer if I don't I won't..... Also as he said something else might kill me first before something related to my valve.
All else being equal I would imagine that having a BAV and having to have any kind of heart surgery isn't going to make you live longer if anything it would have a slightly negative effect one would think. In other words if I had the exact same genetics I have now and the same lifestyle just not the bicuspid valve or aneurysm that would certainly be a plus.
 

Astro

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I think that the paper/editorial numbers sound right. The best paper I could find on this topic was the SWEDEHEART Study (Loss in life expectancy after surgical aortic valve replacement, 2019, vol 74(1), Journal of the American College of Cardiology). This study was big; 23,528 patients. I am no statistician but the methods look reasonable to me.

It found that loss of life expectancy varied with age from 0.4 years for people > 80 years to 4.4 years for people less than 50 years.

This is SO MUCH BETTER than the life expectancy without surgery. It is SO MUCH BETTER than almost any cancer. We so are fortunate to live in an age with such effective treatment for our medical problem.

As Pellicle has stated, these are average life expectancy differences. Any individual may do better (or worse) than the average.

While I view these numbers as mostly encouraging, I also see room for improvement. I think that delaying surgery until permanent heart damage has occurred, will decrease life expectancy. Earlier surgery (but not too early - the valve must have a severe problem) is of benefit. The review, “Early valve replacement for severe aortic valve disease: effect on mortality and clinical ramifications, 2020, Journal of Clinical Medicine” outlines the arguments.

If my life expectancy is 4.4 years shorter, I intend to use my remaining time more wisely. I will get more things done by being more focussed, live life more fully so easily make up the difference.
 

Bmorgan4

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Apr 16, 2021
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I think that the paper/editorial numbers sound right. The best paper I could find on this topic was the SWEDEHEART Study (Loss in life expectancy after surgical aortic valve replacement, 2019, vol 74(1), Journal of the American College of Cardiology). This study was big; 23,528 patients. I am no statistician but the methods look reasonable to me.

It found that loss of life expectancy varied with age from 0.4 years for people > 80 years to 4.4 years for people less than 50 years.

This is SO MUCH BETTER than the life expectancy without surgery. It is SO MUCH BETTER than almost any cancer. We so are fortunate to live in an age with such effective treatment for our medical problem.

As Pellicle has stated, these are average life expectancy differences. Any individual may do better (or worse) than the average.

While I view these numbers as mostly encouraging, I also see room for improvement. I think that delaying surgery until permanent heart damage has occurred, will decrease life expectancy. Earlier surgery (but not too early - the valve must have a severe problem) is of benefit. The review, “Early valve replacement for severe aortic valve disease: effect on mortality and clinical ramifications, 2020, Journal of Clinical Medicine” outlines the arguments.

If my life expectancy is 4.4 years shorter, I intend to use my remaining time more wisely. I will get more things done by being more focussed, live life more fully so easily make up the difference.
This study was followed up on - and they found that the relative life expectancy for BAV was the same across all age groups. BAV patients are typically younger and healthy, compared with unhealthy TAV patients which is why shorter life would be expected. Some images here from the study showing different age groups after valve replacement vs general population. Hope it’s helpful. But I agree - 4.4 is nothing :). I don’t want to live to 90 anyways!! I want to live now!!
 

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pellicle

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Hi
I don’t want to live to 90 anyways!! I want to live now!!
well I want to live as healthy as I can, because even at the age of 57 I can say that the choices you make at 25 impact your health at 55. I'm very glad I made good choices then.

As to 90 ... all I can say is that its no fun living and watching everyone you know and love die from age, cancer or mishap. The answer lies (in my view) in being able to keep making friends who are (preferably) younger than you. I find there's a dual benefit to that and that is they drag you forward into new things (but then I've always been an early adopter anyway) ;-)
 

pellicle

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Hi

long time no see ... hope all's well there
So I was wondering about this myself. I didn't read the stats or the article yet but I would imagine that if you had just a small percentage of people die shortly after surgery due to surgical complications that would skew the numbers a good bit.
indeed this is exactly right and an important thing to always keep in mind with statistics. An outlier or two can make a change to the average, especially with a smaller sample size


age
80​
75​
82​
23​
81​
77​
Average = 69.6666666666667​
 

Astro

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Thank you Bmorgan4 for detailing Glaser's 2021 article. It is reassuring for BAV patients.

This design does have a limitation. It compares people who have had surgery. No one who has a serious secondary problem, for example cancer, will be included. The study population is compared against a population registry which would include people who have cancer or other problems that might exclude major surgery.

I agree with your statement about living until age 90.
 
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