Impact of Sex on Long-Term Outcomes Following Surgical Aortic Valve Replacement

IF 2.2 4区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
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Abstract

Background

The impact of sex on outcomes following surgical aortic valve replacement (SAVR) remains unclear. It has been proposed that females experience inferior outcomes, but this has yet to be conclusively established, particularly in the long term. The objective of this study is to identify discrepancies in postoperative outcomes between males and females following SAVR to better inform consideration for surgical intervention.

Method

We retrospectively reviewed the outcomes of 4,927 patients who underwent SAVR from 2004 to 2018 at our centre. In total, 531 propensity-matched males and females were included in the final analysis. The primary outcome was mortality at any point during the follow-up period. Secondary outcomes included various measures of postoperative morbidity. Follow-up duration was 15 years.

Results

In SAVR all-comers, females experienced inferior short-term mortality, but equivalent mid-term and long-term mortality. Rates of mediastinal bleeding, sternal wound infections, sepsis, heart failure, and pacemaker insertion were all equivalent between the sexes; however, males experienced a higher rate of acute kidney injury and readmission for stroke at the longest follow-up while females experienced a longer intensive care unit and hospital length of stay. In a sub-analysis of isolated SAVR, males and females experienced equivalent early, mid, and late mortality. Of note, a trend towards increased aortic valve reoperation was noted in females at the longest follow-up.

Conclusions

Males and females experience equivalent long-term mortality following isolated SAVR. Sex is not an independent risk factor of poor outcomes post-SAVR; however, the increased preoperative risk profile of females requires diligent consideration.

性别对主动脉瓣置换术后长期疗效的影响
背景:性别对主动脉瓣置换术(SAVR)术后效果的影响仍不明确。有人认为女性的疗效较差,但这一观点尚未得到证实,尤其是在长期疗效方面。本研究的目的是确定男性和女性在 SAVR 术后疗效方面的差异,以便更好地为考虑手术干预提供依据:我们回顾性分析了2004年至2018年在本中心接受SAVR手术的4927名患者的疗效。共有 531 名倾向匹配的男性和女性纳入最终分析。主要结果是随访期间任何时间点的死亡率。次要结果包括各种术后发病率指标。随访时间为15年:结果:在SAVR所有患者中,女性的短期死亡率较低,但中期和长期死亡率相当。纵隔出血、胸骨伤口感染、脓毒症、心力衰竭和起搏器植入的发生率在男女之间是相同的;但是,男性急性肾损伤和中风再入院的发生率在最长随访时间内较高,而女性在重症监护室和医院的住院时间较长。在孤立 SAVR 的子分析中,男性和女性的早期、中期和晚期死亡率相当。值得注意的是,在最长的随访期间,女性主动脉瓣再手术率呈上升趋势:结论:男性和女性在进行孤立的 SAVR 后的长期死亡率相当。性别并不是SAVR术后不良预后的独立风险因素;但是,女性术前风险状况的增加需要认真考虑。
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来源期刊
Heart, Lung and Circulation
Heart, Lung and Circulation CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
4.50
自引率
3.80%
发文量
912
审稿时长
11.9 weeks
期刊介绍: Heart, Lung and Circulation publishes articles integrating clinical and research activities in the fields of basic cardiovascular science, clinical cardiology and cardiac surgery, with a focus on emerging issues in cardiovascular disease. The journal promotes multidisciplinary dialogue between cardiologists, cardiothoracic surgeons, cardio-pulmonary physicians and cardiovascular scientists.
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