Rubens Fraser D, Clarke Anna E, Lee Douglas S, Wells George A, Sun Louise Y
Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.
CJC Open. 2022 Dec 7;5(3):220-229. doi: 10.1016/j.cjco.2022.12.001. eCollection 2023 Mar.
Surgical aortic valve replacement (SAVR) is a key strategy for the treatment of aortic valve disease. However, studies have involved primarily male patients, and whether the benefits of this approach can be extrapolated to female patients is unclear.
Clinical and administrative datasets for 12,207 patients undergoing isolated SAVR in Ontario from 2008 to 2019 were linked. Male and female patients were balanced using inverse probability treatment weighting. Mortality, endocarditis, and major hemorrhagic and thrombotic events, as well as 2 composite outcomes-major adverse cerebral and cardiovascular events (MACCE) and patient-derived adverse cardiovascular and noncardiovascular events (PACE)-and their component events, were compared in the weighted groups with a stratified log-rank test.
A total of 7485 male patients and 4722 female patients were included in the study. Median follow-up was 5.2 years in both sexes. All-cause mortality did not differ between sexes (hazard ratio [HR] 0.949 [95% confidence interval {CI} 0.851-1.059]). Male sex was associated with an increased risk of new-onset dialysis (HR 0.689 [95% CI 0.488-0.974]). Female sex was associated with a significantly increased risk of both new-onset heart failure (HR 1.211 [95% CI 1.051-1.394], = 0.0081) and heart failure hospitalization (HR 1.200 [95% CI 1.036-1.390], = 0.015). No statistically significant differences were seen in any of the other secondary outcomes between sexes.
This population health study demonstrated that survival did not differ between male and female patients undergoing SAVR. Significant sex-related differences were found in the risk of heart failure and new-onset dialysis, but these findings should be considered exploratory and require further study.
外科主动脉瓣置换术（SAVR）是治疗主动脉瓣疾病的关键策略。然而，以往研究主要纳入男性患者，尚不清楚该方法的益处能否外推至女性患者。
将2008年至2019年在安大略省接受单纯SAVR的12207例患者的临床和管理数据集进行关联。采用逆概率处理加权法对男性和女性患者进行平衡。通过分层对数秩检验比较加权组中的死亡率、心内膜炎、主要出血和血栓形成事件，以及2个复合结局——主要不良脑和心血管事件（MACCE）和患者源性不良心血管和非心血管事件（PACE）及其组成事件。
本研究共纳入7485例男性患者和4722例女性患者。两性的中位随访时间均为5.2年。全因死亡率在两性之间无差异（风险比[HR]0.949[95%置信区间{CI}0.851-1.059]）。男性新发透析风险增加（HR0.689[95%CI0.488-0.974]）。女性新发心力衰竭（HR1.211[95%CI1.051-1.394]，P=0.0081）和心力衰竭住院（HR1.200[95%CI1.036-1.390]，P=0.015）的风险均显著增加。两性之间的任何其他次要结局均无统计学显著差异。
这项人群健康研究表明，接受SAVR的男性和女性患者的生存率无差异。在心力衰竭和新发透析风险方面发现了显著的性别差异，但这些发现应被视为探索性的，需要进一步研究。
