Gender and Outcome After Aortic Root Replacement
Hannah L. McMullen, BA, Tsuyoshi Yamabe, MD, Yanling Zhao, MS, Suzuka Nitta, Joseph Sanchez, BS, Saveliy Kelebeyev, BS, Casidhe-Nicole R. Bethancourt, BS, Isaac George, MD, Craig R. Smith, MD, Hiroo Takayama, MD, PhD.
Columbia University College of Physicians & Surgeons, New York, NY, USA.
OBJECTIVE: Worse outcomes in female patients with cardiovascular disease have been highlighted in recent years. This study aims to investigate the influence of female gender on outcomes after aortic root replacement (ARR).
METHODS: Medical records of 848 patients who underwent ARR in our Aortic Center for aortic aneurysm, dissection, or endocarditis were retrospectively reviewed. The primary end point of interest was in-hospital mortality and/or stroke.
RESULTS: Females (n=159/848, 19%) were significantly older (61.3 vs 58.7 (males), p=0.01), with higher rates of pre-existing cerebrovascular disease (14% vs 7%, p=0.01) and previous valve intervention (20% vs 13%, p=0.02), but less prior myocardial infarction (1% vs 7%, p<0.01). The indication for ARR was different (aneurysm 75% vs 87%, dissection 13% vs 6%, p<0.01). There was no difference in in-hospital mortality (3% vs 2%, p=0.57) or stroke (4% vs 4%, p=0.86). (Table 1). Left ventricular ejection fraction (OR 0.95, 95%CI: 0.92- 0.97), renal failure (OR 7.55, 95%CI: 1.14-50.20), and previous cardiac surgery (OR 2.44, 95%CI: 1.20-4.93) were the independent predictors of the primary end point but not female gender (OR 0.59, 95%CI: 0.28-1.25). Propensity score matched analysis confirmed this result. Furthermore, female gender did not result in worse outcome in a subgroup analysis focusing on elective ARR for root aneurysm.
CONCLUSIONS: Despite the differences in baseline characteristics and indication for surgery, females do not appear to be exposed to an increased risk of in-hospital stoke or mortality after ARR.
eGFR: estimated GFR
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