Gender differences in clinical presentation and surgical outcome of aortic stenosis.
BACKGROUND
Little is known about the gender differences of patients undergoing aortic valve replacement (AVR) for isolated severe aortic stenosis.


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 cm(2) vs men 0.7+/-0.2 cm(2); 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).


CONCLUSIONS
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.
Fuchs
Christina
C
Department of Cardiology, Medical University of Vienna, University Hospital, Waehringer Guertel 18-20, A-1090 Vienna, Austria. julia.mascherbauer@meduniwien.ac.at
Mascherbauer
Julia
J
Rosenhek
Raphael
R
Pernicka
Elisabeth
E
Klaar
Ursula
U
Scholten
Christine
C
Heger
Maria
M
Wollenek
Gregor
G
Czerny
Martin
M
Maurer
Gerald
G
Baumgartner
Helmut
H
D000368:Aged; D001021:Aortic Valve / Q000473:pathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D017023:Coronary Angiography; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D011300:Preoperative Care; D012737:Sex Factors; D016896:Treatment Outcome