Are Women at Higher Risk for Isolated Surgical Aortic Valve Replacement? Results From 178,000 STS Adult Cardiac Surgery Database Patients.

Background: Female sex is a well-established risk factor for morbidity and mortality in cardiac surgery.

Aims: This study aimed to assess the characteristics and contemporary outcomes of surgical aortic valve replacement (SAVR) in women compared to men.

Methods: All patients who underwent isolated SAVR from 2014 through 2022 were identified using the Society of Thoracic Surgery national database. Patient characteristics were compared between women and men. The primary interest of outcomes was operative mortality.

Results: A total of 178,014 patients undergoing isolated SAVR were identified, including 64,684 36.3%) women and 113,330 (63.7%) men. Women were older (66.1 years vs. 63.6 years in men, SMD = 0.21) and had a smaller body surface area (1.84 vs. 2.09 m² in men, SMD = 1.15). A history of infective endocarditis was more common in men (10.5% vs. 5.4% in women, SMD = 0.19), while women were more likely to undergo annular enlargement (8.4% vs. 2.9% in men, SMD = 0.24). Propensity score matching yielded 33,228 pairs in each sex category. After matching, operative mortality was comparable (2.2% in women vs. 1.7% in men, SMD = 0.04). Likewise, postoperative complications were similarly observed.

Conclusion: Women undergoing isolated SAVR demonstrated similar morbidity and mortality compared to men despite having smaller body surface area and higher frequency of annular enlargement. Given the improved outcomes with contemporary practice in SAVR, sex may no longer be a risk factor for worse outcomes in isolated SAVR.