Impact of Sex on Mortality in Patients Undergoing Surgical Aortic Valve Replacement

Abstract

Aortic stenosis (AS) is the second most common valvular heart disease in the United States. Although the prevalence of AS does not significantly differ between the sexes, there is some controversy on whether sex differences affect the long-term mortality of patients with severe AS undergoing surgical aortic valve replacement (SAVR). Therefore, we retrospectively analyzed the medical records of 917 patients (female, n = 424 [46.2%]) with severe AS who had undergone isolated SAVR at a tertiary care center between January 2005 and December 2018. During a median follow-up of 5.2 years, 74 (15.0%) male patients and 41 (9.7%) female patients died. The Kaplan–Meier analysis revealed that the 10-year mortality rate was significantly higher in male than female patients (24.7% vs. 17.9%, log-rank p = 0.005). In the sequential Cox proportional hazard regression model for assessing long-term mortality up to 10 years post-surgery, the adjusted hazard ratio of male sex for mortality was 1.93 (95% confidence interval, 1.28–2.91; p = 0.002). The association between male sex and postoperative long-term mortality was not significantly diminished by any demographic or clinical factor in subgroup analyses. In conclusion, female sex was significantly associated with better long-term survival in patients with severe AS undergoing SAVR.

Systematic review and meta-analysis of the impact of sex on outcomes after aortic valve replacement

“…Ten-year mortality ranged from 10.0 to 44.1% for men and 11.0 to 39.1% for women 23,24,27,29,31,33,35 . One study found a significant difference in survival at 10 years, with 44.1 and 30.0% mortality rates for men and women who received bioprosthetic aortic valve replacements, respectively ( P < 0.0001), but no difference in mortality for those who had received mechanical SAVR ( P = 0.74) 28 .…”

“…Intraoperative parameters Significant differences in the distribution of prosthesis type between the sexes was noted in eight studies, with six reporting significantly more women undergoing AVR with a bioprosthesis. 21,24,25,27,29,35 Overall, 18-88.2 and 19.4-89.5% of men and women received a bioprosthesis after excluding one study that solely included patients who underwent mechanical SAVR. 31 Cardiopulmonary bypass and/or aortic-cross clamp times were reported in eight studies.…”

“…Ten-year mortality ranged from 10.0 to 44.1% for men and 11.0 to 39.1% for women. 23,24,27,29,31,33,35 One study found a significant difference in survival at 10 years, with 44.1 and 30.0% mortality rates for men and women who received bioprosthetic aortic valve replacements, Forest plot demonstrating pooled estimates of (a) in-hospital, (b) 30-day, (c) 1-year, (d) 5-year, and (e) 10-year mortality. CI, confidence interval; df, degrees of freedom.…”