Sex-Related Differences in 2197 Patients Undergoing Isolated Surgical Aortic Valve Replacement

Objectives The aim of this study is to evaluate gender-related differences in clinical presentation and mortality in patients undergoing isolated surgical aortic valve replacement (SAVR). Methods We performed a retrospective analysis of all patients undergoing isolated SAVR from 2000 to 2011 in our center. Patient data were compared with regard to gender including baseline characteristics, 30-day, and late mortality. Kaplan-Meier survival curves were used to analyze long-term survival up to 10 years follow-up. Independent risk factors for 30-day and late mortality were identified using a Cox regression model. Results Two thousand one hundred ninety-seven patients were included, 1290 (58.7%) male patients and 907 (41.3%) female patients. Female patients were older (70±11 vs. 64±13 years, p<0.001), presented with higher logistic EuroSCORE (7.5±5.8 vs. 5.6±6%, p=0.006), and more common NYHA class III or IV (71 vs. 65%, p=0.05). Male patients presented more often with LV dysfunction (7.5 vs. 2.8%, p<0.001) and endocarditis (4.1 vs. 1.7%, p<0.001) than female patients. Intraoperatively, female patients were more likely to have had a complete sternotomy (65 vs. 52%, p<0.001) and SAVR with a bioprosthesis (87 vs. 78%, p<0.001). Female patients exhibited a higher 30-day mortality (4.4 vs. 1.6%, p<0.001) and late mortality (13 vs. 9.6%, p=0.04) than male patients. After adjustment for baseline characteristics, only female gender was an independent predictor for 30-day mortality (HR 2.2, 95% CI 0.98 to 5.2, p=0.05) and age as independent predictor for late mortality (HR 1.07, 95% CI 1.03 to 1.1, p<0.001). Conclusion Female patients were older and sicker and may therefore exhibit higher 30-day and late mortality than male patients. Female gender per se was a predictor for 30-day but not for late mortality. doi: 10.1111/jocs.12442