Comparative study of male and female patients undergoing surgical aortic valve replacement

Abstract

Background Sex does have an effect on disease perception and outcomes after cardiac surgery. Objectives Quantify the differences in cardiovascular risk profiles within an age-matched cohort and assess the long-term survival differences in males and females who underwent surgical aortic valve replacement with or without concomitant coronary artery bypass surgery. Methods All-comers patients who underwent surgical aortic valve replacement with or without coronary artery bypass surgery were included. Characteristics, clinical features, and survival up to 30 years were compared between female and male patients. Propensity- and age-matching using propensity scores were used to compare both groups. Results During the total study period between 1987 and 2017, there were 3462 patients (mean age 66.8 (SD:11.1) years, 37.1% female) who underwent surgical aortic valve replacement with or without coronary artery bypass surgery at our institution. In general, female patients were older than male patients (69.1 (SD:10.3) versus 65.5 (SD:11.3), respectively). In the age-matched cohort, female patients were less likely to have multiple comorbidities and undergo concomitant coronary artery bypass surgery. Twenty-year survival following the index procedure was higher in age-matched female patients (27.1%) compared to male patients (24.4%) in the overall cohort), p = 0.018. Conclusions Substantial sex differences in cardiovascular risk profile exist. However, when surgical aortic valve replacement with or without coronary artery bypass surgery is performed, extended long-term mortality is comparable between males and females. More research regarding sex-dimorphic mechanisms of aortic stenosis and coronary atherosclerosis would promote more awareness in terms of sex-specific risk factors after cardiac surgery and contribute to more guided personalized surgery in the future.

Systematic review and meta-analysis of the impact of sex on outcomes after aortic valve replacement

“…Nineteen retrospective studies reviewed outcomes of sex differences in SAVR ± other procedures 12,21–34 . A total of 301 076 patients were included in all studies with data collection dates ranging from 1976 to 2020.…”

“…The pooled estimates for 5-year mortality did not differ significantly different between males and females (OR 0.99, 95% CI, 0.84–1.17; z score = 0.10; P = 0.92) (Fig. 1d) 23,24,26,27,29–31,33 . Heterogeneity between the included studies was considerable (tau 2 = 0.04, chi 2 = 29.87, I 2 = 77%, P = 0.0001).…”

“…Nineteen retrospective studies reviewed outcomes of sex differences in SAVR AE other procedures. 12,[21][22][23][24][25][26][27][28][29][30][31][32][33][34] A total of 301 076 patients were included in all studies with data collection dates ranging from 1976 to 2020. Isolated SAVR data or propensity-matched statistics were utilized where available in the meta-analysis.…”

“…1d). 23,24,26,27,[29][30][31]33 Heterogeneity between the included studies was considerable (tau 2 ¼ 0.04, chi 2 ¼ 29.87, I 2 ¼ 77%, P ¼ 0.0001).…”

“…Ten-year mortality ranged from 10.0 to 44.1% for men and 11.0 to 39.1% for women. 23,24,27,29,31,33,35 One study found a significant difference in survival at 10 years, with 44.1 and 30.0% mortality rates for men and women who received bioprosthetic aortic valve replacements, Forest plot demonstrating pooled estimates of (a) in-hospital, (b) 30-day, (c) 1-year, (d) 5-year, and (e) 10-year mortality. CI, confidence interval; df, degrees of freedom.…”