Sex-Based Differences in Outcomes of Surgical Aortic Valve Replacement: A Meta-Analysis with Reconstructed Time-to-Event Data

TL;DR

This study finds that women have higher early mortality but lower long-term mortality after heart valve surgery compared to men.

Contribution

The study uses reconstructed time-to-event data to reduce confounding bias and compare sex-based outcomes in SAVR.

Findings

Female patients had higher early mortality and more blood product use after SAVR.

Male patients had higher long-term mortality and more reoperations following SAVR.

No significant differences were found in late stroke or bleeding rates between sexes.

Abstract

Results in the literature are mixed on how patient sex impacts the outcomes of surgical aortic valve replacement (SAVR), with a high risk of confounding bias due to different risk profiles at presentation. We aimed to assess short- and long-term outcomes of SAVR in male and female patients.

We searched PubMed, Embase, and the Cochrane Library for eligible confounder-adjusted studies, including those that used propensity-score-matching, multivariable regressions, and inverse probability of treatment weighting. Meta-analysis was performed for short-term (early mortality and procedural complications) and long-term (late mortality, reoperation, and adverse events) endpoints. We compared endpoints, using risk ratio (RR) for short-term endpoints and hazards ratio (HR) for long-term endpoints. We calculated 95% confidence intervals (CIs) for all outcomes. A meta-analysis of Kaplan-Meier-derived individual patient data was done for long-term mortality.

We included 13 studies (n = 159,415). In the short-term, female patients had a higher mortality rate (RR 1.25 [95% CI 1.19, 1.32], P < 0.001), more operative deaths (RR 1.33 [95% CI 1.01, 1.75], P = 0.04), and required more blood product use (RR 1.36 [95% CI 1.14, 1.63], P < 0.001). Male patients had more transient ischemic attacks (RR 0.74 [95% CI 0.56, 0.99], P = 0.04) and acute kidney injury (RR 0.73 [95% CI 0.7, 0.77], P < 0.001). At long-term follow-up, male patients had a higher mortality rate (HR 0.93 [95% CI 0.88, 0.98], P = 0.001), and more reoperations; no significant differences were seen in the rates of late stroke or bleeding.

This meta-analysis found that, compared to male patients, female patients had higher early mortality but lower late mortality following SAVR.

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