Associazione Nazionale Medici Cardiologi Ospedalieri



Relative Survival After Adult Cardiac Surgery in Italy

Rosato Stefano Roma(Roma) – Istituto Superiore di sanità | Biancari Fausto Helsinki, Finland(Helsinki, Finland) – Heart and Lung Center, Helsinki University Hospital, University of Helsinki | D’Errigo Paola Roma(Roma) – Istituto Superiore di Sanità


Although adult cardiac surgery maintains an important role in the management of severe heart diseases also in the current era of constant technological advancements of transcatheter procedures, data on life expectancy of cardiac surgery patients is particular, there is a lack of data on relative survival of frequently performed isolated cardiac surgery procedures.

In this study we estimated the observed 10-year survival in cardiac surgery patients, the expected survival from age- and sex-adjusted general population and the relative survival from a nationwide administrative registry.


This is an observational study from a nationwide administrative registry including all adult patients who underwent cardiac surgery from January 2010 to December 2020, in Italy.

Patients died within 90 days from the procedure have been excluded from this analysis. Age and sex adjusted relative survival of 90-day survivors was estimated using the Hakulinen and Tenkkanen’s method. A relative survival of 1.0 implies that the observed survival is the same as the expected survival in the age- and sex- matched general population.


Data on 394445 consecutive adult patients survived 90 days after cardiac surgery have been analyzed. 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, which means that the observed survival was close to the expected survival of the matched general population. 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 below 0.60 in patients who underwent double or triple valve surgery combined with coronary surgery. Conclusions The present findings provide a picture of the real expectation in terms of late survival of patients after adult cardiac surgery. This information can be useful for a throughout discussion with patients and their relatives on the benefits and risks associated with surgery, and it may be relevant in the decision-making process and in planning tertiary prevention.