Sex Disparities in Elective Valve-Sparing Root Replacement: Evidence From a Multicentre Study

Le résumé fourni par la source

OBJECTIVES: Sex-related disparities are well established in cardiovascular disease, but their impact on outcomes after valve-sparing root replacement (VSRR) is not well defined. In a multicentre international cohort, we evaluated sex-based differences in clinical characteristics, radiographic features and outcomes after elective VSRR. METHODS: We retrospectively analysed all patients who underwent VSRR between 2004 and 2024 at 3 high-volume centres in the United States and Europe. Baseline, operative, and imaging data were compared between sexes. The primary end-point was a composite of all-cause mortality, 30-day cerebrovascular accident, and Zone 0-3 aortic reintervention or aortic valve reintervention. Kaplan-Meier and competing risk analyses were performed, with 4:1 propensity score matching (calliper 0.2) to adjust for baseline imbalances. RESULTS: A total of 1019 patients (191 women, 19%) undergoing VSRR were included in the study. Women were younger (46.7 vs 50.4 years, P = .002), more likely to present with heritable thoracic aortic disease (HTAD) (51% vs 17%, P < .001), and had smaller aortic diameters but larger indexed dimensions compared with men (all P ≤ .001). Aortic valve leaflet repair was performed less frequently in women (17% vs 34%, P < .001). After matching, no significant sex differences were observed in early outcomes. At 10 years, freedom from the composite end-point was similar between women and men (82.8% vs 83.9%, P = .740), as were survival (95.0% vs 96.4%, P = .920) and cumulative incidences of reintervention or dissection. Age thresholds for adverse events were lower in women (>50 years) than in men (>59 years). CONCLUSIONS: Only one-fifth of VSRR patients were women, who presented younger with more HTAD and smaller absolute aortic diameters. Despite these differences, long-term outcomes were equivalent, suggesting that sex alone does not determine surgical results. Earlier surgical referral guided by indexed aortic measurements may improve recognition and outcomes in women.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.