Sex‐related difference in outcomes after aortic root replacement

Abstract

Purpose: Poorer short-term outcomes have been described for females after cardiovascular surgery. We examined the influence of sex on the outcomes after aortic root replacement (ARR). Methods: Medical records of 848 patients (females, n = 159/848, 19%) who underwent ARR at our center from 2005 to 2018 were retrospectively reviewed. Sex differences of the following outcomes were analyzed: the primary end point (inhospital mortality or stro111ke), secondary end point (new requirement for permanent pacemaker), and long-term survival (median follow-up 21.4 months [interquartile range,1.3-60.0]).Results: Females were significantly older (61.3 vs 58.7 [male]) with higher rates of pre-existing cerebrovascular disease (14% [22/159] vs 7% [52/689]) and previous valve intervention (20% [32/159] vs 13% [89/689]) but less myocardial infarction [1%(1/159) vs 7%(48/689)]. The surgical indication was different (aneurysm 75% [120/159] vs 87% [602/689], dissection 13% [21/159] vs 6% [41/689]; P < .01]). Females had larger average aneurysm size after controlling for body size (P ≤ .001). There was no sex difference in in-hospital mortality (3% [5/159] vs 2% [16/689]) or stroke (4% [7/159] vs 4% [29/689]). Multivariable logistic regression indicated that female sex was not an independent predictor of combined in-hospital stroke or death (odds ratio [OR], 0.59; 95% confidence interval [CI], 0.28-1.25), confirmed by propensity score analysis. There was no difference in long-term survival (5-year survival, 90.96% vs 93.03%; P = .44). Females had higher incidence of permanent pacemaker requirement [11% (18/159) vs 6% (39/689), P = .03] and female sex was an independent predictor of permanent pacemaker requirement (OR, 2.01; 95% CI, 1.085-3.724; P = .03).

Sex and Permanent Pacemaker Implantation After Surgical Aortic Valve Replacement

“…Few studies have examined the rate of permanent pacemaker implantation among younger women undergoing surgical AVR, and these studies found a higher incidence of permanent pacemaker implantation rate Ann Thorac Surg 2021;-:--among women. 9,10 The reason for the higher rate of permanent pacemaker implantation rate among women in these previous studies, as well as in our study, is unknown. Because our data did not include information regarding underlying cardiac conduction disorders, this known risk factor for permanent pacemaker implantation could not be accounted for.…”

“…8 Few studies have examined sex differences in the rate of permanent pacemaker implantation after surgical AVR. 9,10 We therefore performed a nationwide population-based cohort study to further investigate whether sex was associated with risk for permanent pacemaker implantation after surgical AVR.…”

Gender Difference is Associated with Short-Term Outcomes in Non-Surgically Managed Acute Aortic Dissection Patients with Hypertension: A Retrospective Cohort Study

“…17 This research adds clarity to the current literature, which has been partly inconsistent in terms of gender-difference after surgery. 11,15 Recent studies indicated that gender difference was associated with the outcomes following thoracic aortic surgery 11 and aortic root replacement. 15 However, multiple medical centers study indicates that gender did not significantly affect the shortterm clinical outcomes and actuarial survival following repair of type A AAD.…”

“…11,15 Recent studies indicated that gender difference was associated with the outcomes following thoracic aortic surgery 11 and aortic root replacement. 15 However, multiple medical centers study indicates that gender did not significantly affect the shortterm clinical outcomes and actuarial survival following repair of type A AAD. 12 An observational study of 9855 type B AAD patients indicated that compared with men, women were more likely to experience endovascular and sustain a perioperative cardiac event with open surgery.…”

“…9,10 To date, some studies focused on sex-related differences in short-term or long-term survival in AAD after surgery. 1,[11][12][13][14][15][16] However, the genderrelated outcome in non-surgically managed with AAD is less well elucidated. Therefore, our objective was to explore the relationship between different gender and short-term outcomes in non-surgically managed AAD of hypertension.…”