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Gender Differences and Early Outcome after Isolated Aortic Valve Surgery: A Nationwide Study
Mostafa M. Mokhles1, Sabrina Siregar2, Michel Versteegh2, Luc Noyez3, Bart van Putte4, Alexander BA Vonk5, Jolien W. Roos-Hesselink1, Ad JJC Bogers1, Johanna JM Takkenberg1.
1Erasmus University Medical Center, Rotterdam, Netherlands, 2Leiden University Medical Center, Leiden, Netherlands, 3Radboud University Medical Center, Nijmegen, Netherlands, 4St Antonius Hospital, Nieuwegein, Netherlands, 5Free University Medical Center, Amsterdam, Netherlands.

OBJECTIVE To compare women with men with respect to baseline characteristics and short-term outcome in a contemporary nationwide cohort of patients that underwent isolated AV surgery. METHODS All patients (N=8717; 56% males (N=4888)) that underwent isolated AV surgery (replacement: N=8612, 98.8%; reconstruction: N=105, 1.2%) in the Netherlands between January 2007 and December 2011 were included in this study. Differences in patient and procedural characteristics, and in-hospital outcome were compared between male en female patients. RESULTS Female patients were generally older (mean age, 71 vs. 66 years,p<0.001) and had higher logistic EuroSCORE (median score, 6.6 vs. 4.3,p<0.001). Male patients presented more often with extracardiac arteriopathy (9.7% versus 6.7%;p<0.001), prior cardiac surgery (12.3% versus 6.9%; p<0.001), renal disease (2.3% versus 1.0%;p<0.001), active endocarditis (5.9% versus 1.7%;p<0.001), critical preoperative state (2.5% versus 1.5%;p=0.002), moderate (15.5% versus 10.4%;p<0.001) or poor (4.2% versus 1.6%;p<0.001) left ventricular function and underwent more often emergent surgery (3.2% versus 1.5%;p<0.001). Female patients underwent more often AV replacement (99.3% versus 98.4%; p<0.001) and received more often stented (68.7% versus 58.4%; p<0.001) and stentless (6.1% versus 3.4%; p<0.001) bioprostheses. Male patients, on the other hand, received more often a mechanical prosthesis (36.5% versus 24.4%; p<0.001). Female patients had comparable in-hospital mortality with male patients (OR 1.20, 95% CI 0.90 - 1.61; p=0.220). In males, the AUC for the logistic EuroSCORE was 0.82 (95% CI 0.78-0.86) versus 0.75 (95% CI 0.69-0.80) in females. The calibration of the logistic EuroSCORE model resulted in p-values of p=0.002 and p=0.0033 for males and females, respectively. CONCLUSIONS Compared to males, female patients undergoing isolated aortic valve surgery are older, but have less EuroSCORE risk factors. The suboptimal performance of EuroSCORE in female patients warrants further exploration of gender-specific determinants of early mortality after isolated aortic valve surgery and calls for the development of gender specific risk stratification models for this group of patients.
Table 1 Multivariate analyses of risk factors associated with in-hospital mortality in male and female patients


Characteristics

Males

Females

OR (95% CI)

p-value

OR (95% CI)

p-value
Age1.07 (1.04-1.10)<0.0011.07 (1.04-1.10)<0.001
Chronic lung disease2.39 (1.40-4.07)0.001
Extracardiac arteriopathy2.31 (1.25-4.24)0.007
Neurological dysfunction2.63 (1.04-6.66)0.042
Prior cardiac surgery2.72 (1.57-4.73)<0.001
Active endocarditis3.48 (1.66-7.30)0.0014.03 (1.43-11.35)0.008
Critical preoperative state3.53 (1.55-8.04)0.003
LV function
Goodreference
Poor3.51 (1.30-9.52)0.014
Recent myocardial infarction4.06 (1.37-12.06)0.0124.71 (1.66-13.33)0.004
Pulmonary hypertension5.67 (2.91-11.04)<0.0012.30 (1.03-5.13)0.042
Prior Valve Surgery5.31 (2.78-10.12)<0.001
Prior Aorta Surgery3.29 (1.24-8.74)0.017
Circ. arrest3.92 (1.33-11.52)0.013

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