Work

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

Year: 2025

Type: review

Study designs: Systematic Review, Meta-Analysis

Abstract: Background There are mixed results in the literature 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 males and females. Methods We searched PubMed, Embase and the Cochrane Library for eligible confounder-adjusted studies, including propensity-score-matched, 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 and hazards ratio (HR) for long-term. We calculated 95% confidence intervals for all outcomes. A meta-analysis of Kaplan-Meier derived individual patient data was done for long-term mortality. Results We included 13 studies (n=159,415). In the short-term, females had higher mortality (RR 1.25 [1.19; 1.32], p<0.001), more operative deaths (RR 1.33 [1.01; 1.75], p=0.04) and required more blood product use (RR 1.36 [1.14; 1.63], p<0.001). Males had more transient ischemic attacks (RR 0.74 [0.56; 0.99], p=0.04) and acute kidney injury (RR 0.73 [0.7; 0.77], p<0.001). At long-term follow-up, males had worse mortality (HR 0.93 [0.88; 0.98], p=0.001) and more reoperations, no significant differences were seen in the rates of late stroke or bleeding. Conclusion This meta-analysis found that, compared to males, females had higher early mortality but lower late mortality following SAVR.

Source: CJC Open

DOI: 10.1016/j.cjco.2025.11.002

Authors: Leo N. Consoli, Mir W. Majeed, Eren Cetinel, Pawel Lajczak, Ilias G. Koziakas, Tulio Caldonazo