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Gender differences in left ventricular functional response to aortic valve replacement

J J Morris1, H V Schaff, C J Mullany

  • 1Division of Thoracic and Cardiovascular Surgery, Mayo Clinic, Rochester, MN 55905.

Circulation
|November 1, 1994
PubMed
Summary
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Gender influences left ventricular (LV) adaptation after aortic valve replacement (AVR), with women showing greater recovery of ejection fraction (EF). However, these gender differences in LV adaptation do not impact overall survival rates post-AVR.

Area of Science:

  • Cardiovascular Surgery
  • Cardiac Physiology
  • Medical Statistics

Background:

  • Analyzing gender disparities in ventricular function and survival post-aortic valve replacement (AVR).
  • Examining baseline characteristics influencing outcomes in 1012 AVR patients (329 women, 683 men) from 1983-1990.

Purpose of the Study:

  • To characterize gender differences in left ventricular (LV) function recovery and survival after AVR.
  • To identify factors influencing LV adaptation and long-term outcomes in male and female AVR patients.

Main Methods:

  • Retrospective analysis of 1012 patients undergoing AVR.
  • Comparison of baseline demographics, preoperative conditions, and surgical procedures between genders.
  • Multivariate Cox regression and regression analysis to assess predictors of mortality and LV function improvement.

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Main Results:

  • Women were older, more frequently had aortic stenosis (AS), and had higher preoperative ejection fraction (EF) but less coronary disease than men.
  • Advanced age, lower preoperative EF, and greater coronary disease extent were associated with lower preoperative EF.
  • Postoperative EF improvement was greater in women than men with preoperative EF ≤ 45%, with female sex predicting early EF improvement.
  • Observed 5-year survival was 81% overall (77% women, 83% men; P < .02).
  • Multivariate analysis identified age, preoperative EF, coronary disease extent, and NYHA class as mortality risk factors, but not female sex.

Conclusions:

  • Gender-related factors significantly influence the left ventricle's adaptive and recovery response to pressure and volume overload post-AVR.
  • Despite differences in LV adaptation, gender does not appear to affect overall survival rates following AVR.