Sex difference in aortic root replacement with a stentless bioprosthesis

European Journal of Cardio-Thoracic Surgery, vol. 67

Abstract

OBJECTIVES: To investigate and quantify differences in survival and reinterventions between sexes after aortic root replacement with a stentless bioprosthesis, stratified for preoperative valve lesion. METHODS: Elective adults undergoing aortic root replacement with the Freestyle bioprosthesis at six North-Atlantic centres were included. Survival analyses were performed using the Kaplan-Meier method or Aalen-Johansen with death as competing risk as relevant. Results were quantified using uni- and multivariable Cox regression tested using a log-rank likelihood ratio test. RESULTS: In total, 884 patients were analysed for a median follow-up time of 10 years. Females were 4 years older. Survival was significantly worse in females operated for aortic valve insufficiency [60.7% and 72.2% for females and males at 14 years, respectively (P = 0.001)], but not for the other indications, even after correction for age. There were no differences in early outcomes or need for reoperation between the sexes and between the different aortic valve pathologies. CONCLUSIONS: Sex difference in survival outcomes depends on pathology, and females have, compared to males, more symptoms preoperatively regardless of type of valve lesion and worse outcome after aortic root replacement due to aortic insufficiency. Updated surgical risk scores should account for interaction between sex and pathology, and the surgical community must raise awareness on risk of patient's or doctors delay to surgery.

Authors 14

1. Hanna Dagnegård

   Rigshospitalet

   Affiliation as printed

   Department of Cardiothoracic Surgery, Rigshospitalet , Copenhagen,

   Department of Cardiothoracic Surgery , Rigshospitalet, Copenhagen,

2. Adriaan W. Schneider corresponding Aachen Department of Cardiothoracic Surgery

   Leiden University Medical Center

   Affiliation as printed

   Department of Cardiothoracic Surgery, Leiden University Medical Center , Leiden,

   Leiden University Medical Center Department of Cardiothoracic Surgery, , Leiden,

3. Natalie Glaser

   Karolinska Institutet · Stockholm South General Hospital

   Affiliation as printed

   Department of Cardiology, Stockholm South General Hospital , Stockholm,

   Department of Molecular Medicine and Surgery, Karolinska Institutet , Stockholm,

   Karolinska Institutet Department of Molecular Medicine and Surgery, , Stockholm,

   Stockholm South General Hospital Department of Cardiology, , Stockholm,

4. Solveig Moss Kolseth

   Haukeland University Hospital

   Affiliation as printed

   Department of Cardiothoracic Surgery, Haukeland University Hospital , Bergen,

   Haukeland University Hospital Department of Cardiothoracic Surgery, , Bergen,

5. Farkas B. Vánky

   Linköping University Hospital

   Affiliation as printed

   Department of Cardiothoracic Surgery, Linköping University Hospital , Linköping,

   Linköping University Hospital Department of Cardiothoracic Surgery, , Linköping,

6. Tómas Guðbjartsson

   National University Hospital of Iceland

   Affiliation as printed

   Department of Cardiothoracic Surgery, University Hospital , Reykjavik,

   University Hospital Department of Cardiothoracic Surgery, , Reykjavik,

7. Rune Haaverstad

   Haukeland University Hospital

   Affiliation as printed

   Department of Cardiothoracic Surgery, Haukeland University Hospital , Bergen,

   Haukeland University Hospital Department of Cardiothoracic Surgery, , Bergen,

8. Alex Cotovanu Aachen Department of Cardiothoracic Surgery

   Leiden University Medical Center

   Affiliation as printed

   Department of Cardiothoracic Surgery, Leiden University Medical Center , Leiden,

   Leiden University Medical Center Department of Cardiothoracic Surgery, , Leiden,

9. Ulrik Sartipy

   Karolinska University Hospital · Karolinska Institutet

   Affiliation as printed

   Department of Cardiothoracic Surgery, Karolinska University Hospital , Stockholm,

   Department of Molecular Medicine and Surgery, Karolinska Institutet , Stockholm,

   Karolinska Institutet Department of Molecular Medicine and Surgery, , Stockholm,

   Karolinska University Hospital Department of Cardiothoracic Surgery, , Stockholm,

10. Robert J.M. Klautz Aachen Department of Cardiothoracic Surgery

    Leiden University Medical Center

    Affiliation as printed

    Department of Cardiothoracic Surgery, Leiden University Medical Center , Leiden,

    Leiden University Medical Center Department of Cardiothoracic Surgery, , Leiden,

11. Morten Holdgaard Smerup

    Rigshospitalet

    Affiliation as printed

    Department of Cardiothoracic Surgery, Rigshospitalet , Copenhagen,

    Department of Cardiothoracic Surgery , Rigshospitalet, Copenhagen,

12. Jesper Hjortnaes Aachen Department of Cardiothoracic Surgery

    Leiden University Medical Center

    Affiliation as printed

    Department of Cardiothoracic Surgery, Leiden University Medical Center , Leiden,

    Leiden University Medical Center Department of Cardiothoracic Surgery, , Leiden,

13. Jan Brink Valentin
14. Søren Paaske Johnsen