Gender-based outcomes following surgical aortic valve replacement: a multicentre propensity score matching analysis

De Paulis R, Bakhtiary F, El-Sayed Ahmad A, Andreas M, Autschbach R, Benedikt P, Binder K, Bonaros N, Borger M, Bourguignon T, Canovas S, Coscioni E, Dagenais F, Demers P, Dewald O, Doll N, Feyrer R, Geißler HJ, Grabenwöger M, Grünenfelder J, Kueri S, Lam KY, Langanay T, Laufer G, Van Leeuwen W, Karimli S, Liebold A, Mariscalco G, Massoudy P, Mehdiani A, Pessotto R, Pollari F, Pöling J, Polvani G, Ricci A, Roussel JC, Salamate S, Siepe M, Stefano P, Strauch J, Theron A, Vötsch A, Weber A, Wendler O, Thielmann M, Eden M, Botta B, Bramlage P, Meuris B, Zierer A (2025)

Publication Type: Journal article

Publication year: 2025

Journal

Book Volume: 67

Article Number: ezaf099

Journal Issue: 7

DOI: 10.1093/ejcts/ezaf099

Abstract

OBJECTIVES: This study investigated the gnder-based difference in three-year clinical outcomes, left ventricular (LV) regression, and quality-of-life (QoL) following surgical aortic valve replacement (SAVR) by propensity score matching (PSM). METHODS: A prospective multicentre study on combined data from two prospective registries, INDURE and IMPACT, resulted in 993 patients (735 males and 258 females). PSM yielded 689 patients: 442 males and 247 females undergoing first-time SAVR using Edwards INSPIRIS RESILIA. RESULTS: In the PSM cohort, females had lower body mass index (median 27.9 vs 28.6 kg/m²; P ¼ 0.004), higher European System for Cardiac Operative Risk Evaluation (EuroSCORE) II (2.4 ± 3.0 % vs 1.8 ± 1.9 %; P < 0.001), Society of Thoracic Surgeons (STS) score (1.8 ± 1.7 % vs 1.3 ± 2.0 %; P < 0.001) and were most often in New York Heart Association class III/IV (45.7 % vs 37.6 %; P < 0.021), angina CCS class III/IV (6.1 % vs 2.9 %; P < 0.001) than males. Post-SAVR clinical outcomes up to three years were similar between both genders. Significant differences existed for LV regression after surgery between genders at up to three years (P < 0.001) with better haemodynamic performance. Hypertension slowed the LV mass regression, mildly affecting LV restoration in females for up to three years. In both genders, New York Heart Association status was restored within one year (P < 0.001) and maintained for up to three years (P < 0.001). At three years, QoL significantly improved. CONCLUSIONS: Despite females presenting with a significantly higher surgical risk profile, three-year outcomes following SAVR were comparable between genders with significant improvement in functional status. However, the degree of QoL improvement differed between genders.

Authors with CRIS profile

Involved external institutions

Ospedali Riuniti San Giovanni di Dio e Ruggi d'Aragona Italy (IT) CHU de Québec-Université Laval Canada (CA) Institut de Cardiologie de Montréal Canada (CA) Schüchtermann-Klinik Bad Rothenfelde Germany (DE) Universitätsklinikum Bonn Germany (DE) Steiermärkische Krankenanstaltengesellschaft m. b. H. LKH-Univ. Klinikum Graz Austria (AT) Universitätsklinikum St. Pölten Austria (AT) Erasmus University Medical Center (MC) Netherlands (NL) Julius-Maximilians-Universität Würzburg Germany (DE) Universitätsklinikum Ulm Germany (DE) Glenfield Hospital United Kingdom (GB) Klinikum Passau Germany (DE) Universitätsklinikum Düsseldorf Germany (DE) Royal Infirmary of Edinburgh NHS Trust United Kingdom (GB) Klinikum Nürnberg Germany (DE) Centro Cardiologico Monzino (IRCCS) Italy (IT) Careggi University Hospital / Azienda Ospedaliero Universitaria Careggi Italy (IT) Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil Germany (DE) Hôpital de la Timone France (FR) Paracelsus Medizinische Privatuniversität Austria (AT) HerzZentrum Hirslanden Zurich Switzerland (CH) King's College Hospital (KCH) United Kingdom (GB) Universitätsklinikum Essen Germany (DE) Universitätsklinikum Aachen (UKA) Germany (DE) Ruprecht-Karls-Universität Heidelberg Germany (DE) IPPMed - Institut für Pharmakologie und Präventive Medizin GmbH Germany (DE) Kepler Universitätsklinikum (KUK) Austria (AT) Medizinische Universität Innsbruck Austria (AT) Herzzentrum Leipzig Germany (DE) Wiener Gesundheitsverbund Kliniken Austria (AT) François Rabelais University Tours France (FR) Hirslanden AG / Privatklinikgruppe Hirslanden Switzerland (CH) Hospital Clínico Universitario Virgen de la Arrixaca Spain (ES) Universitäts-Herzzentrum Freiburg - Bad Krozingen GmbH Germany (DE) Catharina Hospital / Catharina Ziekenhuis Netherlands (NL) Centre hospitalier universitaire de Rennes / CHU Rennes France (FR) Nantes University Hospital / Centre hospitalier universitaire de Nantes (CHU) France (FR) University Hospital Leuven (UZ) / Universitaire ziekenhuizen Leuven Belgium (BE)

How to cite

APA:

De Paulis, R., Bakhtiary, F., El-Sayed Ahmad, A., Andreas, M., Autschbach, R., Benedikt, P.,... Zierer, A. (2025). Gender-based outcomes following surgical aortic valve replacement: a multicentre propensity score matching analysis. European Journal of Cardio-Thoracic Surgery, 67(7). https://doi.org/10.1093/ejcts/ezaf099

MLA:

De Paulis, Ruggero, et al. "Gender-based outcomes following surgical aortic valve replacement: a multicentre propensity score matching analysis." European Journal of Cardio-Thoracic Surgery 67.7 (2025).

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