(CCSP113) IMPACT OF SEX ON LONG-TERM OUTCOMES FOLLOWING SURGICAL AORTIC VALVE REPLACEMENT

Background: Contemporary literature has demonstrated inferior outcomes for females in various cardiovascular disease states and interventions. Differences in baseline characteristics, patient presentation, and intraoperative parameters have been proposed to underlie this discrepancy. Previous studies investigating sex differences in outcomes of surgical aortic valve replacement (SAVR) have indicated conflicting results and hence there remains a lack of clarity on whether female sex is an independent risk factor for inferior outcomes. In this retrospective, propensity-matched, single-center study we compare the 15-year outcomes of isolated surgical aortic valve replacement (SAVR).

METHODS AND RESULTS: 4927 patients underwent SAVR at the Mazankowski Alberta Heart Institute between 2004-2018. Propensity-matching identified 531 males and females who underwent isolated SAVR. The primary outcome was all-cause mortality during the follow-up period. Secondary outcomes consisted of intraoperative parameters and several measures of postoperative morbidity, including readmission for myocardial infarction (MI), stroke, or redo aortic valve replacement (AVR). There was no significant difference in the baseline characteristics between the propensity-matched groups. Cardiopulmonary bypass (109±37 vs 103±29 minutes; p=0.011) and aortic cross-clamp times (83±27 vs 79±25 minutes; p=0.037) were significantly longer in males as compared to females. There was no difference in the proportion of mechanical and tissue valves implanted between the sexes. No significant difference in mortality at 30-days (0.8% vs 1.5%; p=0.247), 1 year (4.0% vs 4.0%; p=0.988), 5 years (9.6% vs 10.6%; p=0.550), or 15 years (16.2% vs 16.4%, p=0.714) was identified. Redo aortic valve replacement trended towards favouring males at the longest available follow-up (2.8% vs 1.3%; p=0.067); however, all other measures of postoperative morbidity were comparable between groups with no significant differences noted.

Conclusion: This study examined the long-term outcomes of propensity-matched males and females undergoing isolated surgical aortic valve replacement and identified no significant differences in outcomes over a 15-year follow-up period. Despite previous literature reporting inferior outcomes for females following aortic valve surgery, by accounting for baseline patient characteristics and concomitant procedures equivalent rates of postoperative morbidity and mortality are apparent. Consequently, sex does not appear to be an independent risk factor following isolated surgical aortic valve replacement.