Sex difference in aortic root replacement with a stentless bioprosthesis†.

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Bioprosthetic Valve Research

Background:

• Aortic root replacement is a critical procedure for various valve pathologies.
• Understanding sex-based differences in outcomes is essential for personalized patient care.
• Stentless bioprostheses are commonly used, necessitating evaluation of their long-term performance stratified by sex.

Purpose of the Study:

• To compare survival and reintervention rates between sexes following aortic root replacement using a stentless bioprosthesis.
• To investigate if preoperative valve lesion type influences sex-based outcome disparities.
• To quantify survival differences using robust statistical methods.

Main Methods:

• Analysis of 884 adult patients undergoing elective aortic root replacement with the Freestyle bioprosthesis across six centers.
• Survival analysis using Kaplan-Meier or Aalen-Johansen methods, accounting for competing risks.
• Uni- and multivariable Cox regression models to identify predictors of outcome.

Main Results:

• Median follow-up was 10 years; females were 4 years older on average.
• Females with aortic valve insufficiency showed significantly worse survival (60.7% vs. 72.2% at 14 years, P=0.001).
• No significant sex differences in survival were observed for other indications or in early outcomes/reoperation rates.

Conclusions:

• Sex disparities in survival after aortic root replacement are pathology-dependent.
• Females with aortic insufficiency experience worse outcomes, potentially due to preoperative symptoms and delayed intervention.
• Surgical risk scores should incorporate sex-pathology interactions, and awareness of delayed treatment is crucial.