• Monna E Myllykangas, Jenni Aittokallio, Jarmo Gunn, Jussi Sipilä, Päivi Rautava, and Ville Kytö.
• Department of Anaesthesiology and Intensive Care, University of Turku, Turku, Finland; Division of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland. Electronic address: monna.myllykangas@tyks.fi.
• J. Cardiothorac. Vasc. Anesth. 2020 Apr 1; 34 (4): 932-939.

ObjectivesWomen are considered to have poorer prognoses after cardiac surgery, although evidence is scarce. The authors studied sex differences and long-term outcomes after surgical aortic valve replacement (SAVR).DesignNationwide retrospective cohort study.SettingSix public hospitals and 2 private hospitals.ParticipantsAll first-time SAVR (±coronary artery bypass surgery) patients (excluding endocarditis) aged ≥18 with a prosthetic valve were retrospectively identified from a national registry (n = 7616). Propensity score matching identified 2814 men and 2814 women with comparable baseline features.InterventionsNo intervention.Measurements And Main ResultsOutcomes were survival, major bleeding, ischemic stroke, infective endocarditis, and reoperation. Ten-year survival was 66.8% in men and 67.5% in women (hazard ratio [HR] 1.09; p = 0.107). Major bleeding occurred in 21.5% of men and 19.7% of women (HR 1.36; confidence interval [CI] 1.13-1.63; p = 0.0009) within 10 years, with similar results for mechanical and biological prosthesis. Bleeding was gastrointestinal in 38.5%, intracranial in 27.6%, and 33.9% in other sites with no sex difference in location. Ischemic stroke occurred in 12.5% of men and 13.3% of women within 10 years (HR 1.06; p = 0.614), and 4.7% of men and 2.6% of women (HR 1.77; CI 1.24-2.51; p = 0.001) had infective endocarditis, but association was present only with biological prosthesis (interaction p = 0.02). Aortic valve re-surgery was more common in men at 1 (HR 2.98; CI 1.27-7.00; p = 0.013) and 5 years after SAVR, but not at 10 years (2.4% v 3.8%; p = 0.189).ConclusionsBaseline-matched long-term survival after SAVR is similar between sexes. Men had increased risk of bleeding, early re-surgery after SAVR, and infective endocarditis when using biological prosthesis.Copyright © 2019 Elsevier Inc. All rights reserved.

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