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Multicenter Study
. 2025 Jul 1;67(7):ezaf099.
doi: 10.1093/ejcts/ezaf099.

Gender-based outcomes following surgical aortic valve replacement: a multicentre propensity score matching analysis†

Ruggero De Paulis  1 , Farhad Bakhtiary  2 , Ali El-Sayed Ahmad  2 , Martin Andreas  3 , Rüdiger Autschbach  4 , Peter Benedikt  5   6 , Konrad Binder  7 , Nikolaos Bonaros  8 , Michael Borger  9 , Thierry Bourguignon  10 , Sergio Canovas  11 , Enrico Coscioni  12 , Francois Dagenais  13 , Philippe Demers  14 , Oliver Dewald  15 , Nicolas Doll  16 , Richard Feyrer  17 , Hans-Joachim Geißler  5   6 , Martin Grabenwöger  18 , Jürg Grünenfelder  19 , Sami Kueri  20 , Ka Yan Lam  21 , Thierry Langanay  22 , Günther Laufer  3 , Wouter Van Leeuwen  23 , Seymur Karimli  24 , Andreas Liebold  25 , Giovanni Mariscalco  26 , Parwis Massoudy  27 , Arash Mehdiani  28   29 , Renzo Pessotto  30 , Francesco Pollari  31 , Jochen Pöling  16 , Gianluca Polvani  32 , Alessandro Ricci  1 , Jean-Christian Roussel  33 , Saad Salamate  2 , Matthias Siepe  20   34 , Pierluigi Stefano  35 , Justus Strauch  36 , Alexis Theron  37 , Andreas Vötsch  38 , Alberto Weber  39 , Olaf Wendler  40 , Matthias Thielmann  29 , Matthias Eden  41 , Beate Botta  42 , Peter Bramlage  42 , Bart Meuris  43 , Andreas Zierer  5   6
Affiliations
Multicenter Study

Gender-based outcomes following surgical aortic valve replacement: a multicentre propensity score matching analysis†

Ruggero De Paulis et al. Eur J Cardiothorac Surg. .

Abstract

Objectives: This study investigated the gnder-based difference in three-year clinical outcomes, left ventricular (LV) regression, and quality-of-life (QoL) following surgical aortic valve replacement (SAVR) by propensity score matching (PSM).

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.

Keywords: Aortic stenosis; Gender disparities; Surgical aortic valve replacement.

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