Sex-Based Differences in Outcomes of Surgical Aortic Valve Replacement: A Meta-Analysis with Reconstructed...

Results in the literature are mixed on how patient sex impacts the outcomes of surgical aortic valve replacement (SAVR), with a high risk of confounding bias due to different risk profiles at presentation. We aimed to assess short- and long-term outcomes of SAVR in male and female patients.

We searched PubMed, Embase, and the Cochrane Library for eligible confounder-adjusted studies, including those that used propensity-score-matching, multivariable regressions, and inverse probability of treatment weighting. Meta-analysis was performed for short-term (early mortality and procedural complications) and long-term (late mortality, reoperation, and adverse events) endpoints. We compared endpoints, using risk ratio (RR) for short-term endpoints and hazards ratio (HR) for long-term endpoints. We calculated 95% confidence intervals (CIs) for all outcomes. A meta-analysis of Kaplan-Meier-derived individual patient data was done for long-term mortality.

We included 13 studies (n = 159,415). In the short-term, female patients had a higher mortality rate (RR 1.25 [95% CI 1.19, 1.32], P < 0.001), more operative deaths (RR 1.33 [95% CI 1.01, 1.75], P = 0.04), and required more blood product use (RR 1.36 [95% CI 1.14, 1.63], P < 0.001). Male patients had more transient ischemic attacks (RR 0.74 [95% CI 0.56, 0.99], P = 0.04) and acute kidney injury (RR 0.73 [95% CI 0.7, 0.77], P < 0.001). At long-term follow-up, male patients had a higher mortality rate (HR 0.93 [95% CI 0.88, 0.98], P = 0.001), and more reoperations; no significant differences were seen in the rates of late stroke or bleeding.

This meta-analysis found that, compared to male patients, female patients had higher early mortality but lower late mortality following SAVR.