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Sex Disparities in Elective Valve-Sparing Root Replacement: Evidence From a Multicentre Study.

Murat Yildiz1,2, Maria Nucera2, Maximillian Kreibich3

  • 1Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA 19104, United States.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|January 28, 2026
PubMed
Summary
This summary is machine-generated.

Women undergoing valve-sparing root replacement (VSRR) present with unique characteristics but experience similar long-term outcomes as men. Earlier referral based on indexed aortic measurements may improve recognition and outcomes for women.

Keywords:
aortic aneurysmaortic surgeryheritable thoracic aortic diseasesex differencesvalve-sparing root replacement

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Area of Science:

  • Cardiovascular Surgery
  • Thoracic Aortic Disease
  • Sex-Based Disparities in Medicine

Background:

  • Sex-related disparities in cardiovascular disease are established, yet their specific impact on outcomes following valve-sparing root replacement (VSRR) remains unclear.
  • Understanding these differences is crucial for optimizing patient care and surgical strategies in VSRR.

Purpose of the Study:

  • To evaluate sex-based differences in clinical characteristics, radiographic features, and long-term outcomes among patients undergoing elective VSRR.
  • To identify potential factors influencing outcomes and inform future management strategies.

Main Methods:

  • Retrospective analysis of 1,019 patients undergoing VSRR at three high-volume international centers (2004-2024).
  • Comparison of baseline, operative, and imaging data between sexes.
  • Propensity score matching (4:1) to adjust for baseline imbalances and Kaplan-Meier/competing risk analyses for outcomes.

Main Results:

  • Women (19%) were younger, more likely to have heritable thoracic aortic disease, and had smaller absolute aortic diameters but larger indexed dimensions compared to men.
  • Aortic valve leaflet repair was less frequent in women.
  • After matching, no significant sex differences were observed in early outcomes; 10-year freedom from the composite endpoint (mortality, stroke, reintervention) was similar (82.8% vs 83.9%).

Conclusions:

  • Despite distinct baseline characteristics, long-term outcomes after VSRR are equivalent between sexes.
  • Sex alone does not appear to determine surgical results in VSRR.
  • Earlier surgical referral for women, guided by indexed aortic measurements, may enhance recognition and improve outcomes.