title: Gender differences in the long-term outcomes after valve replacement surgery.
abstract: OBJECTIVE
  To compare the long-term outcomes in women and men after valve replacement surgery.
  
  
  METHODS
  Observational study.
  
  
  METHODS
  Postoperative aortic valve replacement (AVR) or mitral valve replacement (MVR).
  
  
  METHODS
  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.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Kulik
authors.forename: B-K
authors.initials: BK
authors.lastname: Lam
authors.forename: F D
authors.initials: FD
authors.lastname: Rubens
authors.forename: P J
authors.initials: PJ
authors.lastname: Hendry
authors.forename: R G
authors.initials: RG
authors.lastname: Masters
authors.forename: W
authors.initials: W
authors.lastname: Goldstein
authors.forename: P
authors.initials: P
authors.lastname: Bédard
authors.forename: T G
authors.initials: TG
authors.lastname: Mesana
authors.forename: M
authors.initials: M
authors.lastname: Ruel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001705:Bioprosthesis; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011475:Prosthesis Failure; D012086:Reoperation; D012737:Sex Factors; D015996:Survival Rate; D016896:Treatment Outcome