Relative Survival After Adult Cardiac Surgery: Analysis of the Italian Nationwide Registry Data

Stefano Rosato; Fausto Biancari; Paola D'Errigo; Valerio Manno; Fulvia Seccareccia; Marcello Cuomo; Giorgia Duranti; Giovanni Baglio

doi:10.1053/j.jvca.2023.07.016

Relative Survival After Adult Cardiac Surgery: Analysis of the Italian Nationwide Registry Data

J Cardiothorac Vasc Anesth. 2023 Nov;37(11):2223-2227. doi: 10.1053/j.jvca.2023.07.016. Epub 2023 Jul 18.

Authors

Stefano Rosato¹, Fausto Biancari², Paola D'Errigo¹, Valerio Manno³, Fulvia Seccareccia¹, Marcello Cuomo⁴, Giorgia Duranti⁴, Giovanni Baglio⁴

Affiliations

¹ Center for Global Health, Italian Institute of Health, Rome, Italy.
² Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland; Department of Medicine, South-Karelia Central Hospital, University of Helsinki, Lappeenranta, Finland. Electronic address: faustobiancari@yahoo.it.
³ Technical-Scientific Service of Statistics, Italian National Institute of Health, Rome, Italy.
⁴ Italian National Agency for Regional Healthcare Services, Rome, Italy.

PMID: 37543476
DOI: 10.1053/j.jvca.2023.07.016

Abstract

Objective: The authors aimed to investigate life expectancy after adult cardiac surgery.

Setting: Nationwide study including University and non-University hospitals.

Participants: Consecutive adult patients who underwent heart valve and coronary artery surgery from a nationwide administrative registry.

Interventions: Surgical procedures on the heart valves and coronary arteries.

Methods: The authors estimated the 10-year relative survival of adult patients who underwent surgery for heart valve diseases and coronary artery disease taken from a nationwide administrative registry.

Measurements and results: Overall, data on 415,472 patients were available for this study. Among them, 394,445 (94.9%) survived 90 days after surgery, and their 10-year survival was 58.0% (95% CI 57.8-58.3); the expected survival was 70.1%, and the relative survival was 0.83 (95% CI 0.82-0.83). Patients who underwent surgical repair of the mitral valve and aortic valve had relative survival of 0.96 and 0.92, respectively. Isolated coronary artery bypass grafting had a relative survival of 0.88. Surgical replacement of the heart valves had a relative survival below 0.80. Poor results with relative survival <0.70 were observed after complex cardiac surgery. Relative survival was <0.60 in patients who underwent double- or triple-valve surgery combined with coronary artery surgery. The authors observed markedly lower relative survival among women (0.77, 95% CI 0.77-0.78) compared with men (0.86, 95% CI 0.85-0.86) at 10 years. Such a difference was observed after almost all different procedures.

Conclusions: The present findings provided a picture of the real expectation in terms of the late survival of patients after having undergone adult cardiac surgery. This information should be communicated to patients and their relatives before surgery, and it may be relevant in the decision-making process and in planning tertiary prevention.

Keywords: cardiac surgery; expected survival; relative survival; survival.