Are outcomes in surgery for infective endocarditis sex-related?

Infective endocarditis (IE) remains a severe and complex disease with persistently high morbidity and mortality despite advances in diagnosis and treatment. Sex-related differences in cardiovascular disease are well established, yet their influence on the surgical management and outcomes of IE remains poorly understood. This review aims to synthesize current evidence on how sex impacts the clinical presentation, surgical decision-making, and postoperative outcomes in patients with IE.

A structured literature search was conducted. Twenty-five original studies and two recent systematic reviews (one with meta-analysis) were included.

IE is generally more prevalent in men, who more frequently undergo surgical intervention, particularly for aortic valve involvement. In contrast, women tend to be older at diagnosis and have a higher burden of comorbidities such as diabetes and chronic kidney disease. Despite having similar surgical indications, women are less frequently referred for surgery and experience higher perioperative mortality. Several studies reported higher short-term mortality in female patients, while others found no significant differences between sexes. Long-term outcomes were more variable, being comparable between sexes in some studies.

These findings highlight the need for greater awareness of sex-related differences in IE and the importance of incorporating sex-specific factors into clinical decision-making and future research. Addressing these disparities may contribute to more equitable treatment strategies and improved outcomes for both sexes.