Male-female differences in aortic valve and combined aortic valve/coronary surgery: a national cohort study in the Netherlands

Abstract

ObjectiveThe outcome of female patients after adult cardiac surgery has been reported to be less favourable compared with the outcome of male patients. This study compares men with women with respect to patient and procedural characteristics and early mortality in a contemporary national cohort of patients who underwent aortic valve (AV) and combined aortic valve/coronary (CABG/AV) surgery.MethodsAll patients who underwent AV (n=8717, 56% male) or a combined CABG/AV surgery (n=5867, 67% male) in the Netherlands between January 2007 and December 2011 were included.ResultsIn both groups, women were generally older than men (p<0.001) and presented with higher logistic EuroSCORES. In isolated AV surgery, men and women had comparable in-hospital mortality (OR 1.20, 95% CI 0.90 to 1.61; p=0.220). In concomitant CABG/AV surgery, in-hospital mortality was higher in women compared with men (OR 2.00, 95% CI 1.44 to 2.79; p<0.001). The area under the curve for logistic EuroSCORE 1 was systematically higher for men versus women in isolated AV surgery 0.82 (95% CI 0.78 to 0.86) vs 0.75 (95% CI 0.69 to 0.80) and in concomitant CABG/AV surgery 0.78 (95% CI 0.73 to 0.82) vs 0.69 (95% CI 0.63 to 0.74). Finally, (the weight of) risk factors associated with in-hospital mortality differed between men and women.ConclusionsThere are substantial male-female differences in patient presentation and procedural aspects in isolated AV and concomitant CABG/AV surgery in the Netherlands. Further studies are necessary to explore the mechanisms underlying the observed differences. In addition, the observation that standard risk scores perform worse in women warrants exploration of male-female specific risk models for patients undergoing cardiac surgery.Brief title:

Animal studies for the evaluation of in situ tissue-engineered vascular grafts — a systematic review, evidence map, and meta-analysis

“…Next to age, there are differences in the manifestation of CVD between male and female patients. Sex-dependent differences within the cardiovascular system in general 47 – 49 and in outcome after treatment with a cardiovascular prosthesis are known 50 – 52 . In our subgroup analysis on sex, we found no significant differences in patency rates of in situ TEVGs between male and female animals.…”

Sex differences in risks of in-hospital and late outcomes after cardiac surgery: a nationwide population-based cohort study

“…In addition, there has been no strong agreement on the prognosis of valve surgery as compared with that of CABG. [5][6][7][8][9][10] Although some studies demonstrated the…”

“…Most articles have discussed CABG, but the outcomes of valvular surgeries have been less frequently mentioned. In addition, there has been no strong agreement on the prognosis of valve surgery as compared with that of CABG 5–10. Although some studies demonstrated the outcome of single-valve surgery,5 7–10 other conditions remain to be investigated, such as multiple-valve surgery and concomitant CABG and valve surgery.…”

Long Term Health Outcomes Following Coronary Artery Bypass Grafting: A Different Journey for Men and Women

“…Long term data pertaining to the relative survival of male and female patients following CABG is sparse. The predominant view from the literature [5][6][7][8][9] is that women fare worse than men following CABG, although there is some evidence to suggest that the gender gap is slowly closing 8 . Suggested explanations for this disparity in survival rate between the sexes are that women present at older ages with more advanced states of disease 5,6,9 , and that women also have, on average, more comorbidities 5 .…”

“…The predominant view from the literature [5][6][7][8][9] is that women fare worse than men following CABG, although there is some evidence to suggest that the gender gap is slowly closing 8 . Suggested explanations for this disparity in survival rate between the sexes are that women present at older ages with more advanced states of disease 5,6,9 , and that women also have, on average, more comorbidities 5 . These effects are potentially compounded by the smaller diameters of female coronary vessels making these more difficult to revascularise and more susceptible to the effect of narrowing than equivalent vascular damage in men 10 .…”