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Sex-Based Differences in Outcomes of Surgical Aortic Valve Replacement: A Meta-Analysis with Reconstructed
Leo N Consoli1, Mir W Majeed2, Eren Cetinel3
1Federal University of Bahia, Salvador, Brazil.
CJC Open
|March 16, 2026
Summary
Female patients experienced higher early mortality but lower late mortality after surgical aortic valve replacement (SAVR). This meta-analysis clarifies sex-based outcomes in SAVR patients.
Area of Science:
- Cardiovascular Surgery
- Medical Outcomes Research
- Sex Differences in Medicine
Background:
- Existing literature presents conflicting results regarding the impact of patient sex on outcomes following surgical aortic valve replacement (SAVR).
- A significant risk of confounding bias exists due to differing baseline risk profiles between male and female patients undergoing SAVR.
Purpose of the Study:
- To comprehensively assess and compare the short- and long-term outcomes of SAVR in male versus female patients.
- To address confounding factors by analyzing confounder-adjusted studies.
Main Methods:
- A systematic literature search was conducted across PubMed, Embase, and the Cochrane Library for relevant studies.
- Meta-analysis techniques, including propensity-score matching and multivariable regressions, were employed to analyze both short-term (mortality, complications) and long-term (mortality, reoperation, adverse events) endpoints.
- Risk ratios (RR) and hazards ratios (HR) were calculated with 95% confidence intervals (CIs); individual patient data from Kaplan-Meier curves were used for long-term mortality analysis.
Main Results:
- The meta-analysis included 13 studies with 159,415 patients.
- Short-term findings indicated higher mortality (RR 1.25), operative deaths (RR 1.33), and blood product use in females, while males had more transient ischemic attacks (RR 0.74) and acute kidney injury (RR 0.73).
- Long-term results showed higher mortality (HR 0.93) and reoperation rates in males, with no significant sex differences in late stroke or bleeding.
Conclusions:
- Female patients exhibit increased early mortality following SAVR compared to males.
- Conversely, male patients demonstrate higher late mortality and reoperation rates after SAVR.
- This study highlights significant sex-based differences in both short- and long-term outcomes after surgical aortic valve replacement.
Keywords:
aortic valve surgeryhealth equityhealthcare disparitiessurgical aortic valve replacementvalve disease
