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

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.