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DOI: 10.1055/s-0032-1332619
Sex-related differences in patients undergoing isolated surgical aortic valve replacement for severe aortic stenosis
Aims: Significant differences in clinical presentation and outcomes among gender have been demonstrated in patients undergoing coronary bypass surgery. In isolated aortic replacement however, it is controversial if female gender truly influences early and late mortality.
Aim: To evaluate gender related differences in clinical presentation and mortality in patients undergoing isolated surgical aortic valve replacement (SAVR).
Methods: We performed a retrospective analysis of all patients undergoing SAVR from 2001 to 2011 in our centre. Patient demographics and clinical outcomes were prospectively entered into a dedicated database. We compared baseline characteristics, procedural characteristics, and postoperative morbidity and mortality at 30-day and 12 years follow-up among genders. Kaplan-Meier survival curves and the log-rank test were used to analyse long-term survival. Predictors for 30-day and late mortality were identified using a Cox Proportion regression model.
Results: 2197 patients were included, 1290 (58.7%) male patients and 907 (41.3%) female patients. Female patients were older (70 ± 11 vs. 64 ± 13 years, p < 0.001), presented with higher Logistic EuroScore (7.5 ± 5.8 vs. 5.6 ± 6%, p = 0.006) and lower NYHA class III or IV (71 vs. 65%, p = 0.05). Male patients presented more often with LV dysfunction (EF< 35%) (7.5 vs. 2.8%, p < 0.001) and endocarditis (4.1 vs. 1.7%, p < 0.001) than female patients.
Female patients were more likely to undergo complete sternotomy (65 vs. 52%, p < 0.001) and replacement with a bioprosthesis (87 vs. 78%, p < 0.001) than males.
Postoperatively, female patients experienced more respiratory insufficiency (14.4 vs. 10.3%, p = 0.001) and required intra-aortic balloon pump support (1.2 vs. 0.4%, p = 0.02) than male patients.
Female patients exhibited an unadjusted higher 30-day mortality (4.4 vs. 1.6%, p < 0.001) and late mortality (13 vs. 9.6%) as compared to male patients. After adjustment for baseline characteristics, only age emerged as independent predictor of late mortality (HR 1.07, 95% CI 1.03 – 1.1, p < 0.001).
Conclusion: Female gender was associated with higher 30-day and late mortality after isolated aortic valve replacement. Age was the only independent predictor of late mortality in patients undergoing isolated SAVR.