RT Journal Article
SR Electronic
T1 Gender differences in the long-term outcomes after valve replacement surgery
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 318
OP 326
DO 10.1136/hrt.2008.146688
VO 95
IS 4
A1 A Kulik
A1 B-K Lam
A1 F D Rubens
A1 P J Hendry
A1 R G Masters
A1 W Goldstein
A1 P Bédard
A1 T G Mesana
A1 M Ruel
YR 2009
UL http://heart.bmj.com/content/95/4/318.abstract
AB 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.