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Sex‐related difference in outcomes after aortic root replacement
Author(s) -
McMullen Hannah,
Yamabe Tsuyoshi,
Zhao Yanling,
Kurlansky Paul,
Sanchez Joseph,
Kelebeyev Saveliy,
Bethancourt CasidheNicole R.,
George Isaac,
Smith Craig R.,
Takayama Hiroo
Publication year - 2020
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.14523
Subject(s) - medicine , interquartile range , confidence interval , odds ratio , propensity score matching , stroke (engine) , aneurysm , logistic regression , myocardial infarction , cardiology , surgery , mechanical engineering , engineering
Purpose Poorer short‐term outcomes have been described for females after cardiovascular surgery. We examined the influence of sex on the outcomes after aortic root replacement (ARR). Methods Medical records of 848 patients (females, n = 159/848, 19%) who underwent ARR at our center from 2005 to 2018 were retrospectively reviewed. Sex differences of the following outcomes were analyzed: the primary end point (in‐hospital mortality or stro111ke), secondary end point (new requirement for permanent pacemaker), and long‐term survival (median follow‐up 21.4 months [interquartile range,1.3‐60.0]). Results Females were significantly older (61.3 vs 58.7 [male]) with higher rates of pre‐existing cerebrovascular disease (14% [22/159] vs 7% [52/689]) and previous valve intervention (20% [32/159] vs 13% [89/689]) but less myocardial infarction [1%(1/159) vs 7%(48/689)]. The surgical indication was different (aneurysm 75% [120/159] vs 87% [602/689], dissection 13% [21/159] vs 6% [41/689]; P < .01]). Females had larger average aneurysm size after controlling for body size ( P ≤ .001). There was no sex difference in in‐hospital mortality (3% [5/159] vs 2% [16/689]) or stroke (4% [7/159] vs 4% [29/689]). Multivariable logistic regression indicated that female sex was not an independent predictor of combined in‐hospital stroke or death (odds ratio [OR], 0.59; 95% confidence interval [CI], 0.28‐1.25), confirmed by propensity score analysis. There was no difference in long‐term survival (5‐year survival, 90.96% vs 93.03%; P = .44). Females had higher incidence of permanent pacemaker requirement [11% (18/159) vs 6% (39/689), P = .03] and female sex was an independent predictor of permanent pacemaker requirement (OR, 2.01; 95% CI, 1.085‐3.724; P = .03). Conclusions While female patients have different baseline characteristics and indication for ARR, they are not exposed to an increased risk of in‐hospital mortality or stroke. However, females experience increased incidence of permanent pacemaker requirement.