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Gender Differences Among Bicuspid Aortic Valve Patients Undergoing Aortic Valve Replacement: What Are The Implications?
Adin-Cristian Andrei, S. Chris Malaisrie, Jyothy John Puthumana, Vera Rigolin, Marla Mendelson, Zhi Li, Colleen Clennon, Robert O. Bonow, Patrick M. McCarthy.
Northwestern University, Chicago, IL, USA.

OBJECTIVE: Knowledge of gender differences, including outcomes and resource allocation, among bicuspid aortic valve (BAV) patients undergoing aortic valve replacement (AVR) is sparse.
METHODS: We analyzed 418 consecutive BAV patients (317 men and 101 women) that underwent AVR from 04/2004 to 04/2011 and had assessment of aortic diameter (AD).To reduce gender bias, we used propensity score (PS) matching to adjust for 22 factors, including age, comorbidities, other concomitant surgical procedures and maximal AD.
RESULTS: Women were significantly older than men (61.9±13.6 vs 56.9±12.8 years, p<0.001), had smaller AD (AD < 45 mm: 70% vs 55%, p=0.022) and similar follow-up (4±2.2 vs 4±2.0 years). For the total group, women had longer cross-clamp and bypass times (p<0.001), received smaller valve implants (p<0.001), had longer intensive care unit (ICU) length of stay (LOS) (p=0.016), had more prolonged hospital LOS (third quartile (Q3) 7 vs 6 days, p=0.012), underwent more reoperations for non-cardiac reasons (7% vs 2%, p=0.022) and required more postoperative blood products (55% vs 37%, p<0.001). Operative, discharge and 30-day mortality (1% men vs 2% women, p=0.41) and overall survival (90.6% men vs 89.6% women at 5 years, p=0.73) were similar. Figure 1 histograms indicate excellent PS-matching in the resulting 94 pairs. Women had longer ICU LOS (median 32.3 vs 25.6 hours, p=0.005), more prolonged hospital LOS (Q3 7 vs 6 days, p=0.021), more reoperations for non-cardiac reasons (6% vs 0%, p=0.013), more postoperative blood products (56% vs 36%, p=0.005). Women underwent atrial fibrillation surgical ablation less frequently (3% vs 12%, p=0.026). Operative, discharge and 30-day mortality (1% men vs 2% women, p=0.56) and overall survival (91.3% men vs 91.5% women at 5 years, p=0.57) were similar. There were no aortic valve reinterventions during follow-up.
CONCLUSIONS: Women had significantly longer ICU LOS, more prolonged hospital LOS, more reops for non-cardiac reasons and postoperative blood transfusions. Given these substantial differences, future resource-allocation and cost-effectiveness strategies require enhanced focus on gender differences.


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