Gender differences in the long-term outcomes after valve replacement surgery
- A Kulik1,
- B-K Lam1,
- F D Rubens1,
- P J Hendry1,
- R G Masters1,
- W Goldstein1,
- P Bédard1,
- T G Mesana1,
- M Ruel1,2
- 1Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- 2Department of Epidemiology, University of Ottawa, Ottawa, Ontario, Canada
- Dr Marc Ruel, University of Ottawa Heart Institute, 40 Ruskin Street, Suite 3403, Ottawa, Ontario, Canada K1Y 4W7;
- Accepted 24 June 2008
- Published Online First 24 July 2008
Objective: To compare the long-term outcomes in women and men after valve replacement surgery.
Design: Observational study.
Setting: Postoperative aortic valve replacement (AVR) or mitral valve replacement (MVR).
Patients: 3118 patients (1261 women, 1857 men) who underwent AVR or MVR between 1976 and 2006 (2255 AVR, 863 MVR), with mean follow-up of 5.6 (4.5) years.
Main outcome measures: The independent effect of gender on the risk of long-term complications (reoperation, stroke and death) after valve replacement surgery using multivariate actuarial methods.
Results: After implantation of an aortic valve bioprosthesis, women had a significantly lower rate of reoperation compared to men (comorbidity-adjusted hazard ratio (HR) 0.4; 95% confidence intervals (CI) 0.2 to 0.9). In contrast, if an aortic mechanical prosthesis had been implanted, women were more at risk for late stroke compared to men (HR 1.7; CI 1.1 to 2.7). After adjustment for age and co-morbidities, women had significantly better long-term survival compared to men after bioprosthetic AVR (HR 0.5; CI 0.3 to 0.6), but there was no survival difference between genders after mechanical AVR. Trends existed towards better survival for women after bioprosthetic MVR (HR 0.6; CI 0.4 to 1.0) and mechanical MVR (HR 0.8; CI 0.5 to 1.1).
Conclusion: The long-term outcomes after valve replacement surgery differ between women and men. Although women have more late strokes after valve replacement, they undergo fewer reoperations and have better overall long-term survival compared to men.
Competing interests: None.