Longevity after mechanical aortic root replacement--do men live longer?

To investigate whether longevity after mechanical aortic root replacement is influenced by the patient's gender.

From February 1998 to June 2011, 476 patients (376 men, 100 women, mean age, 53±12 years; range, 18-88) underwent composite aortic root replacement. Of these patients, 398 (312 men) were included in the present analysis. The indications for root replacement were aortic valve dysfunction (mostly stenosis) and concomitant aneurysmal disease in 334 (83.9%), acute type A aortic dissection in 51 (12.8%), and infective endocarditis in 10 (2.5%). Other indications were technical or anatomic considerations (0.8%).

The women who presented for surgery were significantly older (men, 52±12 years vs women, 56±12 years; P=.01). However, no significant differences were found with regard to previous cardiac surgery (5.3%, 20 men [6.4%] vs 1 woman [1.2%]; P=.06), concomitant procedures (38%; 117 men [37.5%] vs 35 women [40.7%]; P=.62), or additive EuroSCORE (men, 5.1±2.2; women, 5.2±2.2; P=.55). The mean diameter of the ascending aorta was not significantly different between the 2 groups (men, 54±9 mm; women, 56±14 mm; P=.97). The median follow-up period was 7.4 years (range, 0-13; 2366 cumulative patient-years), with no significant difference in hospital mortality (men, 6.7% vs women, 10.5%; P=.25). Overall, men enjoyed significantly better longevity than did women. After 10 years, 73%±3% of the men and only 60%±6% of the women were alive (P=.03). Although no long-term survival benefit for either gender was found in an age-matched subgroup among young patients (P=.66), men experienced much more favorable longevity after 55 years of age (P=.04). Consequently, the longevity in men-but not in women-was equal to an age-matched normal population.

Overall, long-term survival after mechanical aortic root replacement was significantly better among men. However, comparing age-matched subgroups≤55 years old, no significantly different life expectancy was found after mechanical root replacement.