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).

Nationwide retrospective cohort study.

Six public hospitals and 2 private hospitals.

All
first-time SAVR (±coronary artery bypass surgery) patients (excluding
endocarditis) aged ≥18 with a prosthetic valve were retrospectively
identified from a national registry (n = 7616). Propensity score
matching identified 2814 men and 2814 women with comparable baseline
features.

No intervention.

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; p = 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;
p = 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; p = 0.614), and 4.7% of men and 2.6% of women
(HR 1.77; CI 1.24-2.51; p = 0.001) had infective endocarditis, but
association was present only with biological prosthesis (interaction
p = 0.02). Aortic valve re-surgery was more common in men at 1 (HR 2.98;
CI 1.27-7.00; p = 0.013) and 5 years after SAVR, but not at 10 years
(2.4% v 3.8%; p = 0.189).

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.