Abstract

Objective: The purpose of this study was to compare the long-term outcomes of 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, 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, 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, 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, 1.0) and mechanical MVR (HR: 0.8; CI: 0.5, 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.