Differences in life expectancy between men and women after aortic valve replacement

Abstract

OBJECTIVES Some researchers have observed an increased number of deaths during the follow-up of young patients who undergo aortic valve replacement due to severe aortic stenosis, suggesting that this procedure does not restore their life expectancy. Our goal was to confirm these findings and explore sex-based differences. METHODS All patients between 50 and 65 years of age who underwent isolated aortic valve replacement in 27 Spanish centres during an 18-year period were included. We compared observed and expected survival at 15 years of follow-up and estimated the cumulative incidence of death from a competing risks point of view. We stratified by sex and analysed if being a woman was an independent risk factor for death. RESULTS For men, the observed survival at 10 and 15 years of follow-up was 85% [95% confidence interval (CI) 83.6%–86.4%] and 72.3% (95% CI 69.7%–74.7%), respectively whereas the expected survival was 88.1% and 78.8%. For women, the observed survival at 10 and 15 years was 85% (95% CI 82.8%–86.9%) and 73% (95% CI 69.1%–76.4%), whereas the expected survival was 94.6% and 89.4%. At 15 years of follow-up, the cumulative incidence of death due to the disease in men and women was 8.2% and 16.7%, respectively. In addition, being a woman was an independent risk factor for death (hazard ratio = 1.23 (95% CI 1.02–1.48; P = 0.03). CONCLUSIONS After the aortic valve replacement, men and women do not have their life expectancy restored, but this loss is much higher in women than in men. In addition, being a woman is a risk factor for long-term death. Reasons for these findings are unknown and must be investigated.

Sex Differences and Similarities in Valvular Heart Disease

“…Sex differences in survival following surgical aortic valve replacement after propensity score matching in the multicenter spanish aortic valve registry. 61 IPW-HR indicates inverse-probability weighted hazard ratio; PASP, pulmonary artery systolic pressure; and TAVR, transcatheter aortic valve replacement.…”

“…Among the compassionate use or early feasibility trials, [144][145][146] women make up 53% to 66% of enrolled patients highlighting the sex differences in prevalence of the disease in this elderly population. 17 Women are diagnosed with significant TR at an older age compared with men (72 [62][63][64][65][66][67][68][69][70][71][72][73][74][75][76][77][78][79] years versus 70 [61][62][63][64][65][66][67][68][69][70][71][72][73][74][75][76][77] years; P=0.003) and the TR cause in women was more often isolated or related to left-sided VHD, whereas men more often had LV dysfunction related TR. 124 After propensity score matching, there was no sex difference in outcomes, however, TR causes remained significantly associated with all-cause mortality with left valvular disease or LV dysfunction related TR had lower survival compared with patients with primary TR (P=0.004 and P=0.019, respectively).…”

“…66–68 Female sex per se’ has been also been reported to be an independent predictor of worse operative mortality and morbidity after SAVR (Figure 3C). 61,66,68…”

“…[66][67][68] Female sex per se' has been also been reported to be an independent predictor of worse operative mortality and morbidity after SAVR (Figure 3C). 61,66,68 Female sex is included as a risk factor in many surgical risk prediction tools such as the Society of Thoracic Surgeons and EuroSCORE calculators. These risk prediction scores are frequently used in clinical practice to select which patients are considered surgical candidates.…”

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

“…Two large multicentre trials have addressed male–female differences in the past [ 27 , 28 ]. In the study of Glaser et al [ 27 ], long-term survival up to 19 years of follow-up is depicted and shown to be great in overall after SAVR; we further expand upon those data and show survival data of up to 30 years of follow-up post-SAVR.…”