Gender-based outcomes following surgical aortic valve replacement: a multicentre propensity score matching analysis

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OBJECTIVES: This study investigated the gnder-based difference in three-year clinical outcomes, left ventricular (LV) regression, and quality-of-life (QoL) following surgical aortic valve replacement (SAVR) by propensity score matching (PSM). METHODS: A prospective multicentre study on combined data from two prospective registries, INDURE and IMPACT, resulted in 993 patients (735 males and 258 females). PSM yielded 689 patients: 442 males and 247 females undergoing first-time SAVR using Edwards INSPIRIS RESILIA. RESULTS: In the PSM cohort, females had lower body mass index (median 27.9 vs 28.6 kg/m2; P = 0.004), higher European System for Cardiac Operative Risk Evaluation (EuroSCORE) II (2.4 ± 3.0 % vs 1.8 ± 1.9 %; P < 0.001), Society of Thoracic Surgeons (STS) score (1.8 ± 1.7 % vs 1.3 ± 2.0 %; P < 0.001) and were most often in New York Heart Association class III/IV (45.7 % vs 37.6 %; P < 0.021), angina CCS class III/IV (6.1 % vs 2.9 %; P < 0.001) than males. Post-SAVR clinical outcomes up to three years were similar between both genders. Significant differences existed for LV regression after surgery between genders at up to three years (P < 0.001) with better haemodynamic performance. Hypertension slowed the LV mass regression, mildly affecting LV restoration in females for up to three years. In both genders, New York Heart Association status was restored within one year (P < 0.001) and maintained for up to three years (P < 0.001). At three years, QoL significantly improved. CONCLUSIONS: Despite females presenting with a significantly higher surgical risk profile, three-year outcomes following SAVR were comparable between genders with significant improvement in functional status. However, the degree of QoL improvement differed between genders. CLINICAL TRIAL REGISTRATION NUMBER: ClinicalTrials.gov NCT04053088/-NCT03666741.

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