Sex Differences in Long-Term Outcomes After Surgical Aortic Valve Replacement: A Nationwide Propensity-matched Study.
J Cardiothorac Vasc Anesth
; 34(4): 932-939, 2020 Apr.
Article
en En
| MEDLINE
| ID: mdl-31732381
ABSTRACT
OBJECTIVES:
Women are considered to have poorer prognoses after cardiac surgery, although evidence is scarce. The authors studied sex differences and long-term outcomes after surgical aortic valve replacement (SAVR).DESIGN:
Nationwide retrospective cohort study.SETTING:
Six public hospitals and 2 private hospitals.PARTICIPANTS:
All first-time SAVR (±coronary artery bypass surgery) patients (excluding endocarditis) aged ≥18 with a prosthetic valve were retrospectively identified from a national registry (nâ¯=â¯7616). Propensity score matching identified 2814 men and 2814 women with comparable baseline features.INTERVENTIONS:
No intervention. MEASUREMENTS AND MAINRESULTS:
Outcomes were survival, major bleeding, ischemic stroke, infective endocarditis, and reoperation. Ten-year survival was 66.8% in men and 67.5% in women (hazard ratio [HR] 1.09; pâ¯=â¯0.107). Major bleeding occurred in 21.5% of men and 19.7% of women (HR 1.36; confidence interval [CI] 1.13-1.63; pâ¯=â¯0.0009) within 10 years, with similar results for mechanical and biological prosthesis. Bleeding was gastrointestinal in 38.5%, intracranial in 27.6%, and 33.9% in other sites with no sex difference in location. Ischemic stroke occurred in 12.5% of men and 13.3% of women within 10 years (HR 1.06; pâ¯=â¯0.614), and 4.7% of men and 2.6% of women (HR 1.77; CI 1.24-2.51; pâ¯=â¯0.001) had infective endocarditis, but association was present only with biological prosthesis (interaction pâ¯=â¯0.02). Aortic valve re-surgery was more common in men at 1 (HR 2.98; CI 1.27-7.00; pâ¯=â¯0.013) and 5 years after SAVR, but not at 10 years (2.4% v 3.8%; pâ¯=â¯0.189).CONCLUSIONS:
Baseline-matched long-term survival after SAVR is similar between sexes. Men had increased risk of bleeding, early re-surgery after SAVR, and infective endocarditis when using biological prosthesis.Palabras clave
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Estenosis de la Válvula Aórtica
/
Prótesis Valvulares Cardíacas
/
Implantación de Prótesis de Válvulas Cardíacas
/
Reemplazo de la Válvula Aórtica Transcatéter
Tipo de estudio:
Etiology_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Límite:
Aged
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Female
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Humans
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Male
Idioma:
En
Año:
2020
Tipo del documento:
Article