title: Gender mismatch in allograft aortic valve surgery.
abstract: OBJECTIVE
  Factors influencing allograft valve failure in adult patients are still under discussion. There is evidence in heart transplantation that gender mismatching may influence patient outcome. In case of aortic valve replacement with a homograft valve, gender matching is not performed routinely. The aim of this study was to investigate the impact of gender mismatch of human aortic homografts.
  
  
  METHODS
  Between June 1992 and August 2009, 363 adult patients received aortic or pulmonary homografts in the aortic position. For 350 patients, the following donor-recipient patterns could be investigated: male recipient and male donor (n = 193), male recipient and female donor (n = 64), female recipient and male donor (n = 47), female recipient and female donor (n = 46).
  
  
  RESULTS
  The overall mortality rate was 18.5%. In total, 95 patients (27.1%) needed reoperation during follow-up (mean overall follow-up time was 8.1 years). Event-free survival (i.e. survival without reoperation) of recipients of gender-incompatible homografts was not significantly different compared with recipients who received gender-compatible homografts. Echocardiographic performance of the homograft valve over time was not significantly worse in case of gender incompatibility than in case of gender compatibility.
  
  
  CONCLUSIONS
  There was no significant difference between gender-mismatched and gender-matched allografts regarding death, need for reoperation and echocardiographic allograft function during follow-up. Limitations of this study are its retrospective design and the lack of immunohistochemical data to determine the presence of viable cells in explanted valves.
authors.affiliation: Department of Internal Medicine, Klinikum Passau, Passau, Germany bernhard.boell@klinikum-passau.de.
authors.forename: Bernhard Michael
authors.initials: BM
authors.lastname: Böll
authors.affiliation: Department of Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany.
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Vogt
authors.affiliation: Institute of Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians University, Munich, Germany.
authors.forename: Anne Laure
authors.initials: AL
authors.lastname: Boulesteix
authors.affiliation: Auto Tissue Berlin GmbH, Berlin, Germany Department of Cardiac Surgery, University Hospitals, Ludwig-Maximilians University, Munich, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Schmitz
mesh_terms: D000328:Adult; D000368:Aged; D064591:Allografts; D001021:Aortic Valve / Q000637:transplantation*; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000601:surgery*; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012737:Sex Factors; D013997:Time Factors; D014019:Tissue Donors; D014184:Transplantation, Homologous
keywords: Aortic homografts; Gender mismatch; Reoperation