title: Sex-related differences in 2197 patients undergoing isolated surgical aortic valve replacement.
abstract: OBJECTIVE
  The aim of this study is to evaluate gender-related differences in clinical presentation and mortality in patients undergoing isolated surgical aortic valve replacement (SAVR).
  
  
  METHODS
  We performed a retrospective analysis of all patients undergoing isolated SAVR from 2000 to 2011 in our center. Patient data were compared with regard to gender including baseline characteristics, 30-day, and late mortality. Kaplan-Meier survival curves were used to analyze long-term survival up to 10 years follow-up. Independent risk factors for 30-day and late mortality were identified using a Cox regression model.
  
  
  RESULTS
  Two thousand one hundred ninety-seven patients were included, 1290 (58.7%) male patients and 907 (41.3%) female patients. Female patients were older (70 ± 11 vs. 64 ± 13 years, p < 0.001), presented with higher logistic EuroSCORE (7.5 ± 5.8 vs. 5.6 ± 6%, p = 0.006), and more common NYHA class III or IV (71 vs. 65%, p = 0.05). Male patients presented more often with LV dysfunction (7.5 vs. 2.8%, p < 0.001) and endocarditis (4.1 vs. 1.7%, p < 0.001) than female patients. Intraoperatively, female patients were more likely to have had a complete sternotomy (65 vs. 52%, p < 0.001) and SAVR with a bioprosthesis (87 vs. 78%, p < 0.001). Female patients exhibited a higher 30-day mortality (4.4 vs. 1.6%, p < 0.001) and late mortality (13 vs. 9.6%, p = 0.04) than male patients. After adjustment for baseline characteristics, only female gender was an independent predictor for 30-day mortality (HR 2.2, 95% CI 0.98 to 5.2, p = 0.05) and age as independent predictor for late mortality (HR 1.07, 95% CI 1.03 to 1.1, p < 0.001).
  
  
  CONCLUSIONS
  Female patients were older and sicker and may therefore exhibit higher 30-day and late mortality than male patients. Female gender per se was a predictor for 30-day but not for late mortality.
authors.affiliation: Clinic for Cardiovascular Surgery, German Heart Centre, Munich, Germany.
authors.forename: Yacine
authors.initials: Y
authors.lastname: Elhmidi
authors.forename: Nicolo
authors.initials: N
authors.lastname: Piazza
authors.forename: Domenico
authors.initials: D
authors.lastname: Mazzitelli
authors.forename: Michael
authors.initials: M
authors.lastname: Wottke
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Lange
authors.forename: Sabine
authors.initials: S
authors.lastname: Bleiziffer
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D001705:Bioprosthesis / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006350:Heart Valve Prosthesis / Q000706:statistics & numerical data; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012737:Sex Factors; D056346:Sternotomy / Q000706:statistics & numerical data; D015996:Survival Rate; D013997:Time Factors