The impact of sex on in-hospital and long-term mortality rates in patients undergoing surgical aortic valve replacement: The SAVR and SEX study

BACKGROUND: Surgical aortic valve replacement (SAVR) is among the most commonly performed valve valvular surgeries. Despite many previous studies conducted in this setting, the impact of gender on outcomes in the patients undergoing SAVR is still unclear. AIMS: To define gender differences in short- and long-term mortality in patients undergoing SAVR. METHODS: We analyzed retrospectively all the patients undergoing isolated SAVR from January 2006 to March 2020 in the Department of Cardiovascular Surgery and Transplantology in John Paul II Hospital in Cracow. The primary end point was in-hospital and long-term mortality. Secondary end points included the length duration of hospital stay and perioperative complications. Groups of men and women with regard to the prosthesis type were compared. Propensity score matching was performed to adjust for differences in baseline characteristics. RESULTS: A total number of 4 510 patients undergoing isolated surgical SAVR were analyzed. A follow-up median (interquartile range [IQR]) was 2120 (1000-3452) days. Females constituted 41.55% of the cohort and were older, displayed more non-cardiac comorbidities and faced a higher operative risk. In both genders, bioprostheses were more often applied (55.5% vs. 44.5%; P < 0.0001). In univariable analysis, gender was not associated linked to in-hospital fatality (3.7% vs. 3%; P = 0.15) and late mortality (rates) (23.37% vs. 23.52 %; P = 0.9). Upon adjustment for baseline characteristics (propensity score matching analysis) and considering 5-year survival, a long-term prognosis proved to be better in women with 86.8% comparing to 82.7% in men (P = 0.03). CONCLUSIONS: A key finding from this study suggests that the female gender was not associated with a higher in-hospital and late mortality rate compared to men. Further studies are needed to confirm long-term benefits in women undergoing SAVR.