Gender differences in clinical presentation and surgical outcome of aortic stenosis

Abstract

Although women referred to AVR are older and more symptomatic, operative and long-term mortality are not increased. In the oldest age group of 79 years and older, women even have a better outcome, presumably due to a longer mean life expectancy.

Sex Differences in the Utilization and Outcomes of Surgical Aortic Valve Replacement for Severe Aortic Stenosis

“…In line with the majority of previous studies, we found distinctive risk profiles for men and women undergoing AVR 4, 6, 11, 12, 17, 27. Women undergoing AVR (isolated or combined) were older and had more nonatherosclerotic comorbid conditions at presentation including hypertension, diabetes mellitus, chronic obstructive pulmonary disease, atrial fibrillation/flutter, and anemia compared with men.…”

“…Regarding disparity in referral for testing, women with AS were less likely to be seen by a specialist and less likely to be referred for testing 19. Regarding disparity in referral to surgery, women diagnosed with AS had unfavorable preoperative baseline characteristics compared with men at the time of presentation and thus were less likely to be referred to surgical treatment 4, 9, 24. Interestingly, this disparity in referral to valve replacement is not seen with the current TAVR practice; in the United States and Germany, women composed 52% and 55%, respectively, of all patients undergoing TAVR, respectively 25, 26.…”

“…The outcomes of AVR have improved significantly nationwide in the past decade 3. Several studies have assessed the differential impact of sex on outcomes of AVR but yielded conflicting results 4, 5, 6, 7, 8, 9, 10, 11, 12, 13. The interest in examining the sex gap in AS patients has been renewed with the introduction and widespread adoption of transcatheter AVR (TAVR).…”

Sex Differences in Severe Aortic Stenosis ― Clinical Presentation and Mortality ―

“…Fuchs et al reported a lower mortality in women after AVR in the ≥79-years age group. 21 In the present study, sex-related differences in survival after AVR in the elderly were also observed in those aged ≥65 years (data not shown). Adjusted 5-year mortality risk of male relative to female patients, however, was neutral, suggesting that the better crude survival rate in women was related to the lower prevalence of measured morbidities in women.…”

“…Morris et al reported increased short-term mortality in women, 19 whereas other reports have indicated better longterm survival in women 21 or no sex-related differences in outcomes. 22 These varying results may be explained by the differences in comorbidities contributing to mortality risks.…”