Sex-related Differences among Patients Undergoing Surgical Aortic Valve Replacement - A Propensity Score Matched Study.

Zierer, Andreas; De Paulis, Ruggero; Bakhtiary, Farhad; Ahmad, Ali El-Sayed; Andreas, Martin; Autschbach, Rüdiger; Benedikt, Peter; Binder, Konrad; Bonaros, Nikolaos; Borger, Michael; Bourguignon, Thierry; Canovas, Sergio; Coscioni, Enrico; Dagenais, Francois; Demers, Philippe; Dewald, Oliver; Feyrer, Richard; Geißler, Hans-Joachim; Grabenwöger, Martin; Grünenfelder, Jürg; ... (2024). Sex-related Differences among Patients Undergoing Surgical Aortic Valve Replacement - A Propensity Score Matched Study. (In Press). Interdisciplinary cardiovascular and thoracic surgery Oxford University Press 10.1093/icvts/ivae140

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OBJECTIVES

We investigated the sex-related difference in characteristics and 2-year outcomes after surgical aortic valve replacement (SAVR) by propensity-score matching (PSM).

METHODS

Data from two prospective registries, INDURE and IMPACT, were merged, resulting in a total of 933 patients: 735 males and 253 females undergoing first-time SAVR. PSM was performed to assess the impact of sex on the SAVR outcomes, yielding 433 males and 243 females with comparable baseline characteristics.

RESULTS

Females had a lower body mass index (BMI; median 27.1 vs 28.0 kg/m2; p = 0.008), fewer bicuspid valves (52% vs 59%; p = 0.036), higher EuroSCORE II (mean 2.3 vs 1.8%; p < 0.001) and STS score (mean 1.6 vs 0.9%; p < 0.001), were more often in NYHA class III/IV (47% vs 30%; p < 0.001) and angina CCS III/IV (8.2% vs 4.4%; p < 0.001), but had a lower rate of myocardial infarction (1.9% vs 5.2%; p = 0.028) compared to males. These differences vanished after PSM, except for EuroSCORE II and STS scores, which were still significantly higher in females. Furthermore, females required smaller valves (median diameter 23.0 vs 25.0 mm, p < 0.001). There were no differences in the length of hospital stay (median 8 days) or ICU stay (median 24 vs 25 hours) between both sexes. At two years, post-SAVR outcomes were comparable between males and females, even after PSM.

CONCLUSIONS

Despite females presenting with a significantly higher surgical risk profile, 2-year outcomes following SAVR were comparable between males and females.

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