Gender-based outcomes following surgical aortic valve replacement: a multicentre propensity score matching analysis†.
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De Paulis Ruggero, Bakhtiary Farhad, Ahmad Ali El-Sayed, Andreas Martin, Autschbach Rüdiger, Benedikt Peter, Binder Konrad, Bonaros Nikolaos, Borger Michael, Bourguignon Thierry, Canovas Sergio, Coscioni Enrico, Dagenais Francois, Demers Philippe, Dewald Oliver, Doll Nicolas, Feyrer Richard, Geißler Hans-Joachim, Grabenwöger Martin, Grünenfelder Jürg, Kueri Sami, Lam Ka Yan, Langanay Thierry, Laufer Günther, Van Leeuwen Wouter, Karimli Seymur, Liebold Andreas, Mariscalco Giovanni, Massoudy Parwis, Mehdiani Arash, Pessotto Renzo, Pollari Francesco, Pöling Jochen, Polvani Gianluca, Ricci Alessandro, Roussel Jean-Christian, Salamate Saad, Siepe Matthias, Stefano Pierluigi, Strauch Justus, Theron Alexis, Vötsch Andreas, Weber Alberto, Wendler Olaf, Thielmann Matthias, Eden Matthias, Botta Beate, Bramlage Peter, Meuris Bart, Zierer Andreas
Аннотация
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.