{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T15:33:38Z","timestamp":1790868818223,"version":"4.1.0"},"reference-count":27,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2020,11,12]],"date-time":"2020-11-12T00:00:00Z","timestamp":1605139200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"RTA Jan Hentschel, Heart Centre, Ume\u00e5"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,4,13]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p\/>\n               <jats:sec>\n                  <jats:title>OBJECTIVES<\/jats:title>\n                  <jats:p>Our goal was to study long-term observed and relative survival after first-time aortic valve replacement surgery with or without concomitant coronary artery bypass surgery with reference to valve morphology (i.e. bicuspid vs tricuspid).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>Consecutive patients (n\u2009=\u20095086) from 3 Swedish hospitals, operated on between 1 January 2005 and 31 December 2016, were included. The 30-day mortality (n\u2009=\u2009116, 2.3%) was excluded from the analysis of long-term observed and relative survival (n\u2009=\u20094970). Observed survival was analysed using Cox regression. Relative survival was calculated as the ratio between observed and expected survival based on data from the general Swedish population, matched for age, sex and calendar year. Risk factors for death were explored using multivariable analysis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>During the follow-up (median 4.7\u2009years) period, 1157 (23%) patients died. Observed survival excluding 30-day mortality was 96.6%, 82.7% and 57.6% after 1, 5 and 10\u2009years. Compared with the general Swedish population, the relative 1-, 5- and 10-year survival rates were 99.0%, 97.5% and 89.0%. Bicuspid morphology was independently associated with higher observed and relative long-term survival. Renal dysfunction, diabetes, chronic obstructive pulmonary disease, heart failure, smoking and atrial fibrillation were associated with higher long-term mortality. Combined surgery was not associated with higher observed or relative mortality.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>Patients with a bicuspid morphology had better prognosis, matching that of the general population. With increased age, long-term relative survival compared favourably with survival in the general Swedish population. Adding coronary artery bypass surgery to an aortic valve replacement procedure did not affect long-term outcome.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ejcts\/ezaa348","type":"journal-article","created":{"date-parts":[[2020,8,20]],"date-time":"2020-08-20T19:08:12Z","timestamp":1597950492000},"page":"570-576","source":"Crossref","is-referenced-by-count":28,"title":["Long-term results after aortic valve replacement for bicuspid or tricuspid valve morphology in a Swedish population"],"prefix":"10.1093","volume":"59","author":[{"given":"Anders","family":"Holmgren","sequence":"first","affiliation":[{"name":"Heart Centre and Department of Public Health and Clinical Medicine, Medicine, Ume\u00e5 University, Ume\u00e5, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tone Bull","family":"Enger","sequence":"additional","affiliation":[{"name":"Clinic of Medicine, St. Olavs University Hospital, Trondheim, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4100-8298","authenticated-orcid":false,"given":"Ulf","family":"N\u00e4slund","sequence":"additional","affiliation":[{"name":"Heart Centre and Department of Public Health and Clinical Medicine, Medicine, Ume\u00e5 University, Ume\u00e5, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1042-3889","authenticated-orcid":false,"given":"Vibeke","family":"Videm","sequence":"additional","affiliation":[{"name":"Department of Clinical and Molecular Medicine, NTNU \u2013 Norwegian University of Science and Technology, Trondheim, Norway"},{"name":"Department of Immunology and Transfusion Medicine, St. Olavs University Hospital, Trondheim, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Solveig","family":"Valle","sequence":"additional","affiliation":[{"name":"Department of Circulation and Medical Imaging, Faculty of Medicine, NTNU-Norwegian University of Science and Technology, Trondheim, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen Julie Dybvad","family":"Evjemo","sequence":"additional","affiliation":[{"name":"Department of Circulation and Medical Imaging, Faculty of Medicine, NTNU-Norwegian University of Science and Technology, Trondheim, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00d6rjan","family":"Friberg","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, \u00d6rebro University, \u00d6rebro, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7838-8162","authenticated-orcid":false,"given":"Alexander","family":"Wahba","sequence":"additional","affiliation":[{"name":"Heart Centre and Department of Public Health and Clinical Medicine, Medicine, Ume\u00e5 University, Ume\u00e5, Sweden"},{"name":"Department of Circulation and Medical Imaging, Faculty of Medicine, NTNU-Norwegian University of Science and Technology, Trondheim, Norway"},{"name":"Clinic of Cardiothoracic Surgery, St. Olavs University Hospital, Trondheim, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,11,12]]},"reference":[{"key":"2021050518302131900_ezaa348-B1","doi-asserted-by":"crossref","first-page":"2776","DOI":"10.1161\/CIRCULATIONAHA.107.740878","article-title":"Natural history of asymptomatic patients with normally functioning or minimally dysfunctional bicuspid aortic valve in the community","volume":"117","author":"Michelena","year":"2008","journal-title":"Circulation"},{"key":"2021050518302131900_ezaa348-B2","doi-asserted-by":"crossref","first-page":"2579","DOI":"10.1016\/j.jacc.2017.03.017","article-title":"Outcomes in transcatheter aortic valve replacement for bicuspid versus tricuspid aortic valve stenosis","volume":"69","author":"Yoon","year":"2017","journal-title":"J Am Coll Cardiol"},{"key":"2021050518302131900_ezaa348-B3","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1016\/j.athoracsur.2005.08.005","article-title":"Time-varying risk factors for long-term mortality after coronary artery bypass graft surgery","volume":"81","author":"Gao","year":"2006","journal-title":"Ann Thorac Surg"},{"key":"2021050518302131900_ezaa348-B4"},{"key":"2021050518302131900_ezaa348-B5","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1177\/1536867X1501500112","article-title":"Estimating and modeling relative survival","volume":"15","author":"Dickman","year":"2015","journal-title":"Stata J"},{"key":"2021050518302131900_ezaa348-B6","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1002\/(SICI)1097-0258(19960229)15:4<361::AID-SIM168>3.0.CO;2-4","article-title":"Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors","volume":"15","author":"Harrell","year":"1996","journal-title":"Statist Med"},{"key":"2021050518302131900_ezaa348-B7","doi-asserted-by":"crossref","first-page":"604","DOI":"10.7326\/0003-4819-150-9-200905050-00006","article-title":"A new equation to estimate glomerular filtration rate","volume":"150","author":"Levey","year":"2009","journal-title":"Ann Intern Med"},{"key":"2021050518302131900_ezaa348-B8","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1177\/1536867X1001000303","article-title":"Comparing the predictive powers of survival models using Harrell's C or Somers' D","volume":"10","author":"Newson","year":"2010","journal-title":"Stata J"},{"key":"2021050518302131900_ezaa348-B9","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1016\/j.cmpb.2006.01.004","article-title":"Relative survival analysis in R","volume":"81","author":"Pohar","year":"2006","journal-title":"Comput Methods Programs Biomed"},{"key":"2021050518302131900_ezaa348-B10","doi-asserted-by":"crossref","first-page":"1741","DOI":"10.1016\/j.compbiomed.2007.04.010","article-title":"Making relative survival analysis relatively easy","volume":"37","author":"Pohar","year":"2007","journal-title":"Comput Biol Med"},{"key":"2021050518302131900_ezaa348-B11"},{"key":"2021050518302131900_ezaa348-B12","doi-asserted-by":"crossref","first-page":"1323","DOI":"10.1136\/heartjnl-2016-309916","article-title":"Contemporary natural history of bicuspid aortic valve disease: a systematic review","volume":"103","author":"Masri","year":"2017","journal-title":"Heart"},{"key":"2021050518302131900_ezaa348-B13","doi-asserted-by":"crossref","first-page":"2144","DOI":"10.1016\/j.jacc.2016.08.045","article-title":"Long-term outcomes in patients with aortic regurgitation and preserved left ventricular ejection fraction","volume":"68","author":"Mentias","year":"2016","journal-title":"J Am Coll Cardiol"},{"key":"2021050518302131900_ezaa348-B14","doi-asserted-by":"crossref","first-page":"e0163754","DOI":"10.1371\/journal.pone.0163754","article-title":"Reduced long-term relative survival in females and younger adults undergoing cardiac surgery: a prospective cohort study","volume":"11","author":"Enger","year":"2016","journal-title":"PLoS One"},{"key":"2021050518302131900_ezaa348-B15","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1016\/S0735-1097(99)00584-7","article-title":"Observed and relative survival after aortic valve replacement","volume":"35","author":"Kvidal","year":"2000","journal-title":"J Am Coll Cardiol"},{"key":"2021050518302131900_ezaa348-B16","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1016\/0735-1097(90)90627-2","article-title":"Long-term relative survival rates after heart valve replacement","volume":"15","author":"Lindblom","year":"1990","journal-title":"J Am Coll Cardiol"},{"key":"2021050518302131900_ezaa348-B17","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1080\/14017430802702291","article-title":"Patients with postoperative atrial fibrillation have a doubled cardiovascular mortality","volume":"43","author":"Ahlsson","year":"2009","journal-title":"Scand Cardiovasc J"},{"key":"2021050518302131900_ezaa348-B18","doi-asserted-by":"crossref","first-page":"1621","DOI":"10.1161\/CIRCULATIONAHA.112.091371","article-title":"Long-term survival after aortic valve replacement among high-risk elderly patients in the United States: insights from the Society of Thoracic Surgeons Adult Cardiac Surgery Database, 1991 to 2007","volume":"126","author":"Brennan","year":"2012","journal-title":"Circulation"},{"key":"2021050518302131900_ezaa348-B19","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1097\/EJA.0b013e3283657829","article-title":"Long-term absolute and relative survival after aortic valve replacement: a prospective cohort study","volume":"30","author":"Lassnigg","year":"2013","journal-title":"Eur J Anaesthesiol"},{"key":"2021050518302131900_ezaa348-B20","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.jacc.2019.04.053","article-title":"Loss in life expectancy after surgical aortic valve replacement: SWEDEHEART study","volume":"74","author":"Glaser","year":"2019","journal-title":"J Am Coll Cardiol"},{"key":"2021050518302131900_ezaa348-B21","doi-asserted-by":"crossref","first-page":"1798","DOI":"10.1007\/s00380-016-0804-3","article-title":"Predictive factors of long-term survival in the octogenarian undergoing surgical aortic valve replacement: 12-year single-centre follow-up","volume":"31","author":"Cappabianca","year":"2016","journal-title":"Heart Vessels"},{"key":"2021050518302131900_ezaa348-B22","doi-asserted-by":"crossref","first-page":"2714","DOI":"10.1093\/eurheartj\/ehi471","article-title":"Decision-making in elderly patients with severe aortic stenosis: why are so many denied surgery?","volume":"26","author":"Iung","year":"2005","journal-title":"Eur Heart J"},{"key":"2021050518302131900_ezaa348-B23","first-page":"312","article-title":"Decision-making and outcomes in severe symptomatic aortic stenosis","volume":"15","author":"Charlson","year":"2006","journal-title":"J Heart Valve Dis"},{"key":"2021050518302131900_ezaa348-B24","doi-asserted-by":"crossref","first-page":"2018","DOI":"10.1016\/j.jacc.2007.08.011","article-title":"Unoperated patients with severe aortic stenosis","volume":"50","author":"Bach","year":"2007","journal-title":"J Am Coll Cardiol"},{"key":"2021050518302131900_ezaa348-B25","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1016\/S0140-6736(14)61347-7","article-title":"The burden of disease in older people and implications for health policy and practice","volume":"385","author":"Prince","year":"2015","journal-title":"Lancet (London, England)"},{"key":"2021050518302131900_ezaa348-B26","doi-asserted-by":"crossref","first-page":"1020","DOI":"10.7326\/0003-4819-129-12-199812150-00005","article-title":"Accuracy of death certificates for coding coronary heart disease as the cause of death","volume":"129","author":"Lloyd-Jones","year":"1998","journal-title":"Ann Intern Med"},{"key":"2021050518302131900_ezaa348-B27","doi-asserted-by":"crossref","first-page":"862","DOI":"10.1016\/j.jclinepi.2005.11.021","article-title":"Clinicians didn't reliably distinguish between different causes of cardiac death using case histories","volume":"59","author":"Mant","year":"2006","journal-title":"J Clin Epidemiol"}],"container-title":["European Journal of Cardio-Thoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ejcts\/article-pdf\/59\/3\/570\/37830694\/ezaa348.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/ejcts\/article-pdf\/59\/3\/570\/37830694\/ezaa348.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,5,6]],"date-time":"2021-05-06T15:02:10Z","timestamp":1620313330000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ejcts\/article\/59\/3\/570\/5975815"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,11,12]]},"references-count":27,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2020,11,12]]},"published-print":{"date-parts":[[2021,4,13]]}},"URL":"https:\/\/doi.org\/10.1093\/ejcts\/ezaa348","relation":{},"ISSN":["1010-7940","1873-734X"],"issn-type":[{"value":"1010-7940","type":"print"},{"value":"1873-734X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,3,1]]},"published":{"date-parts":[[2020,11,12]]}}}