Gender mismatch in allograft aortic valve surgery

Factors influencing allograft valve failure in adult patients are still under discussion. There is evidence in heart transplantation that gender mismatching may influence patient outcome. In case of aortic valve replacement with a homograft valve, gender matching is not performed routinely. The aim of this study was to investigate the impact of gender mismatch of human aortic homografts.

Between June 1992 and August 2009, 363 adult patients received aortic or pulmonary homografts in the aortic position. For 350 patients, the following donor-recipient patterns could be investigated: male recipient and male donor (n = 193), male recipient and female donor (n = 64), female recipient and male donor (n = 47), female recipient and female donor (n = 46).

The overall mortality rate was 18.5%. In total, 95 patients (27.1%) needed reoperation during follow-up (mean overall follow-up time was 8.1 years). Event-free survival (i.e. survival without reoperation) of recipients of gender-incompatible homografts was not significantly different compared with recipients who received gender-compatible homografts. Echocardiographic performance of the homograft valve over time was not significantly worse in case of gender incompatibility than in case of gender compatibility.

There was no significant difference between gender-mismatched and gender-matched allografts regarding death, need for reoperation and echocardiographic allograft function during follow-up. Limitations of this study are its retrospective design and the lack of immunohistochemical data to determine the presence of viable cells in explanted valves.