Gender Does Matter: Gender-Specific Outcome Analysis of 67,855 Heart Transplants

Kaczmarek, Ingo; Meiser, Bruno; Beiras-Fernández, Andrés; Guethoff, Sonja; Überführ, P.; Angele, Martin K.; Seeland, Ute; Hagl, Christian; Reichart, Bruno; Eifert, Sandra

doi:10.1055/s-0032-1331467

Cited by 20 publications

(13 citation statements)

References 15 publications

(31 reference statements)

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“…In recent years, there is increasing attention for gender-specific differences regarding prevalence, treatment and outcome of cardiovascular disease. For coronary artery disease and recently for mitral valve surgery as well for heart-transplantation gender-specific differences in outcome are described [ 1 – 3 ]. There are also well-documented gender differences in abdominal aortic aneurysm disease and outcome after surgical treatment [ 4 – 6 ].…”

Section: Introductionmentioning

confidence: 99%

Gender-Specific Differences in Outcome of Ascending Aortic Aneurysm Surgery

et al. 2015

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ObjectivesGender specific differences receive increasing attention and are known to affect the outcome of cardiovascular diseases. We investigated possible risk-factors for gender-specific differences in ascending aortic aneurysm surgery.Methods548 consecutive patients (male: n = 390, age: 58.3±14.4 years; female: n = 158, age: 65.3±12.9 years) with aneurysms of the ascending aorta eligible for cardiac surgery were retrospectively analyzed.ResultsWomen were significantly older when operation was indicated (p<0.001) and presented with significantly more hypertension (p=0.04) and chronic obstructive pulmonary disease (COPD; p = 0.017), whereas men had significantly more previous cardiac operations (p = 0.016). Normalized aortic diameters (diameter / body surface area) were significantly larger in women (3.10±0.6 cm) vs. (2.75±0,5 cm, p≤0.001) in men, without differences in absolute values (5.74±1.04 cm vs. 5.86±1.34 cm). The aortic arch was significantly more involved in aneurysm formation in women (p = 0.04). Follow-up was available in 93% of the patients with a mean follow-up time of 3.9±3.9 (0-17.8) years. 30-day mortality was 3.5% in men (n=12) and 7.9% in women (n=11; p = 0.058). Univariate regression analysis shows gender specific risk factors for 30-day mortality in men to be age: p = 0.028; myocardial infarction: p = 0.0.24 and in women diameter of the ascending aorta: p=0.014; renal insufficiency: p=0.007. Long-term survival was significantly reduced in women (log-rank p = 0.0052).ConclusionsThe outcome after surgery for ascending aortic aneurysm is less favourable in women with significantly reduced long-term survival and a trend to increased 30-day mortality in this cohort. Larger normalized aortic diameters, higher incidence of involvement of the aortic arch and differences in comorbidities may contribute to gender differences. Women undergo surgery at higher age and more progressed state of aortic disease. Therefore, gender-specific guidelines for ascending replacement may be useful to improve outcome in women.

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Section: Introductionmentioning

confidence: 99%

Gender-Specific Differences in Outcome of Ascending Aortic Aneurysm Surgery

et al. 2015

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“…In our study, the impact of worse renal function on mortality was rather close to the level of statistical significance. The impact of recipient and donor sex on postoperative outcomes has been a point of controversy, as has been the importance of sex-specific donor-recipient matching ( 9 , 11 ). Our study did not support any inferior sex-specific outcomes, but was not powered to investigate the potentially important male to female mismatches among donors and recipients.…”

Section: Discussionmentioning

confidence: 99%

Pretransplant and perioperative predictors of early heart transplantation outcomes

et al. 2014

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AimTo identify predictors of 3-month mortality after heart transplantation in a Croatian academic center.MethodsA retrospective review of institutional database identified 117 heart transplantations from January 2008 to July 2014. Two children <14 years were excluded from the study. The remaining 115 patients were dichotomized into survivors and non-survivors adjudicated at 3-months postoperatively, and their demographic, clinical, and longitudinal hemodynamic data were analyzed.Results3-month survival after heart transplantation was 86%. Non-survivors were older (59 ± 8 vs 50 ± 14 years, P = 0.009), more likely to have previous cardiac surgery (44% vs 19%; odds ratio [OR] 3.28, 95% confidence interval [CI] 1.08-9.90; P = 0.029), lower body mass index (BMI) (25 ± 4 vs 28 ± 2 kg/m2, P = 0.001), and be diabetics (44% vs 23%; OR 2.57, 95% CI 0.86-7.66; P = 0.083). Creatinine clearance was marginally superior among survivors (59 ± 19 vs 48 ± 20 mL/min, P = 0.059). Donor age and sex did not affect outcomes. Non-survivors were more likely to have had ischemic cardiomyopathy (69% vs 32%, P = 0.010). Postoperative utilization of epinephrine as a second line inotropic agent was a strong predictor of mortality (63% vs 7%; OR 21.91; 95% CI 6.15-78.06; P < 0.001). Serum lactate concentrations were consistently higher among non-survivors, with the difference being most pronounced 2 hours after cardiopulmonary bypass (9.8 ± 3.5 vs 5.2 ± 3.2 mmol/L, P < 0.001). The donor hearts exhibited inferior early hemodynamics in non-survivors (cardiac index 3.0 ± 1.0 vs 4.0 ± 1.1 L/min/m2, P = 0.001), stroke volume (49 ± 24 vs 59 ± 19 mL, P = 0.063), and left and right ventricular stroke work indices (18 ± 8 vs 30 ± 11 g/beat/m2, P < 0.001 and 5 ± 3 vs 7 ± 4 g/beat/m2, P = 0.060, respectively). Non-survivors were more likely to require postoperative re-sternotomy (50% vs 12%; OR 7.25, 95% CI 2.29-22.92; P < 0.001), renal replacement therapy (RRT) (69% vs 9%; OR 22.00, 95% CI 6.24-77.54; P < 0.001), and mechanical circulatory assistance (MCS) (44% vs 5%; OR 14.62, 95% CI 3.84-55.62; P < 0.001). Binary logistic regression revealed recipient age (P = 0.024), serum lactates 2 hours after CPB (P = 0.007), and epinephrine use on postoperative day 1 (P = 0.007) to be independently associated with 3-month mortality.ConclusionPretransplant predictors of adverse outcome after heart transplantation were recipient age, lower BMI, ischemic cardiomyopathy, reoperation and diabetes. Postoperative predictors of mortality were inferior donor heart hemodynamics, epinephrine use, and serum lactate concentrations. Non-survivors were more likely to require re-sternotomy, MCS, and RRT.

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“…Kaczmarek et al [ 41 ] reported the highest 1-year survival in male recipients of male donor hearts (mR/mD: 83.74%). Male recipients of female donor organs (mR/fD: 78.95%) showed the lowest 1-year outcome.…”

Section: Economic Considerations Related To Cardiovascular Risk Factomentioning

confidence: 99%

“…The combination male recipient/female donor carries a higher risk for early mortality, whereas female recipient/male donor reveals favorable short-term results. Gender-matched HTx would be ideal but is not suitable in practice because of organ shortage [ 41 ].…”

Section: Economic Considerations Related To Cardiovascular Risk Factomentioning

confidence: 99%

Applying the Gender Lens to Risk Factors and Outcome after Adult Cardiac Surgery

et al. 2014

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Background: Applying the gender lens to risk factors and outcome after adult cardiac surgery is of major clinical interest, as the inclusion of sex and gender in research design and analysis may guarantee more comprehensive cardiovascular science and may consecutively result in a more effective surgical treatment as well as cost savings in cardiac surgery. Methods: We have reviewed classical cardiovascular risk factors (diabetes, arterial hypertension, hyperlipidemia, smoking) according to a gender-based approach. Furthermore, we have examined comorbidities such as depression, renal insufficiency, and hormonal influences in regard to gender. Gender-sensitive economic aspects have been evaluated, surgical outcome has been analyzed, and cardiovascular research has been considered from a gender perspective. Results: The influence of typical risk factors and outcome after cardiac surgery has been evaluated from a gender perspective, and the gender-specific distribution of these risk factors is reported on. The named comorbidities are listed. Economic aspects demonstrated a gender gap. Outcome after coronary and valvular surgeries as well as after heart transplantation are displayed in this regard. Results after postoperative use of intra-aortic balloon pump are shown. Gender-related aspects of clinical and biomedical cardiosurgical research are reported. Conclusions: Female gender has become an independent risk factor of survival after the majority of cardiosurgical procedures. Severely impaired left ventricular ejection fraction independently predicts survival in men, whereas age does in females.

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Gender Does Matter: Gender-Specific Outcome Analysis of 67,855 Heart Transplants

Abstract: The combination male recipient/female donor carries a higher risk for early mortality, whereas female recipients/male donor reveals favorable short-term results. Gender-matched HT would be ideal, but not suitable in practice because of the shortage of organs.

Cited by 20 publications

References 15 publications

Gender-Specific Differences in Outcome of Ascending Aortic Aneurysm Surgery

Gender-Specific Differences in Outcome of Ascending Aortic Aneurysm Surgery

Pretransplant and perioperative predictors of early heart transplantation outcomes

Applying the Gender Lens to Risk Factors and Outcome after Adult Cardiac Surgery

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