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- Title
Sex-related difference in outcomes after aortic root replacement.
- Authors
McMullen, Hannah; Yamabe, Tsuyoshi; Zhao, Yanling; Kurlansky, Paul; Sanchez, Joseph; Kelebeyev, Saveliy; Bethancourt, Casidhe‐Nicole R.; George, Isaac; Smith, Craig R.; Takayama, Hiroo; Bethancourt, Casidhe-Nicole R
- Abstract
<bold>Purpose: </bold>Poorer short-term outcomes have been described for females after cardiovascular surgery. We examined the influence of sex on the outcomes after aortic root replacement (ARR).<bold>Methods: </bold>Medical records of 848 patients (females, n = 159/848, 19%) who underwent ARR at our center from 2005 to 2018 were retrospectively reviewed. Sex differences of the following outcomes were analyzed: the primary end point (in-hospital mortality or stro111ke), secondary end point (new requirement for permanent pacemaker), and long-term survival (median follow-up 21.4 months [interquartile range,1.3-60.0]).<bold>Results: </bold>Females were significantly older (61.3 vs 58.7 [male]) with higher rates of pre-existing cerebrovascular disease (14% [22/159] vs 7% [52/689]) and previous valve intervention (20% [32/159] vs 13% [89/689]) but less myocardial infarction [1%(1/159) vs 7%(48/689)]. The surgical indication was different (aneurysm 75% [120/159] vs 87% [602/689], dissection 13% [21/159] vs 6% [41/689]; P < .01]). Females had larger average aneurysm size after controlling for body size (P ≤ .001). There was no sex difference in in-hospital mortality (3% [5/159] vs 2% [16/689]) or stroke (4% [7/159] vs 4% [29/689]). Multivariable logistic regression indicated that female sex was not an independent predictor of combined in-hospital stroke or death (odds ratio [OR], 0.59; 95% confidence interval [CI], 0.28-1.25), confirmed by propensity score analysis. There was no difference in long-term survival (5-year survival, 90.96% vs 93.03%; P = .44). Females had higher incidence of permanent pacemaker requirement [11% (18/159) vs 6% (39/689), P = .03] and female sex was an independent predictor of permanent pacemaker requirement (OR, 2.01; 95% CI, 1.085-3.724; P = .03).<bold>Conclusions: </bold>While female patients have different baseline characteristics and indication for ARR, they are not exposed to an increased risk of in-hospital mortality or stroke. However, females experience increased incidence of permanent pacemaker requirement.
- Subjects
CARDIAC pacemakers; HOSPITAL mortality; CEREBROVASCULAR disease; BODY size; SURGICAL indications; CARDIOVASCULAR surgery
- Publication
Journal of Cardiac Surgery, 2020, Vol 35, Issue 5, p1010
- ISSN
0886-0440
- Publication type
journal article
- DOI
10.1111/jocs.14523