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Gender differences in clinical presentation and surgical outcome of aortic stenosis
  1. Christina Fuchs1,
  2. Julia Mascherbauer1,
  3. Raphael Rosenhek1,
  4. Elisabeth Pernicka2,
  5. Ursula Klaar1,
  6. Christine Scholten1,
  7. Maria Heger1,
  8. Gregor Wollenek3,
  9. Martin Czerny3,
  10. Gerald Maurer1,
  11. Helmut Baumgartner1
  1. 1Department of Cardiology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
  2. 2Department of Medical Statistics, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
  3. 3Department of Cardiothoracic Surgery, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
  1. Correspondence to Dr Julia Mascherbauer, Department of Cardiology, Medical University of Vienna, University Hospital, Waehringer Guertel 18–20, A-1090 Vienna, Austria; julia.mascherbauer{at}


Background Little is known about the gender differences of patients undergoing aortic valve replacement (AVR) for isolated severe aortic stenosis.

Methods and Results 408 consecutive patients (215 women and 193 men; p=0.9) were analysed. At presentation, women were older (73.7±9.3 years vs men 66.5±11.5 years; p<0.001), more symptomatic (New York Heart Association (NYHA) class: women 2.3±0.7 vs men 2.0±0.65; p<0.001), and presented with smaller valve areas (women 0.6±0.2 cm2 vs men 0.7±0.2 cm2; p<0.001) and higher mean pressure gradients (women 67.3±19.2 mm Hg vs men 62.2±20.0 mm Hg, p=0.001). Despite older age and more advanced disease in women, operative mortality did not differ. Survival after AVR by Kaplan–Meier analysis tended to be even better in women (92.8%, 89.8%, 81.4% vs men 89.1%, 86.6%, 76.3% at 1, 2 and 5 years, p=0.31). After division into age quintiles, the outcome of women was significantly better in patients older than 79 years (p=0.005). After adjustment for clinical characteristics, gender did not predict operative mortality and late outcome. Despite physical improvement in both groups after surgery, women remained more symptomatic (NYHA class: women 1.6±0.7 vs men 1.3±0.4; p=0.001).

Conclusion Although women referred to AVR are older and more symptomatic, operative and long-term mortality are not increased. In the oldest age group of 79 years and older, women even have a better outcome, presumably due to a longer mean life expectancy.

  • Aortic valve disease
  • gender
  • surgery-valve

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  • Competing interests None.

  • Ethics approval The Ethics Committee of the Medical University of Vienna approved the study protocol.

  • Provenance and peer review Not commissioned; externally peer reviewed.