(P261) SEX DIFFERENCE AND SIMILARITIES IN PATIENTS UNDERGOING A ROSS PROCEDURE

Background: Several studies have reported lower survival in women after aortic valve replacement. Some studies have hypothesized that this difference may be due to a higher incidence of patient-prosthesis mismatch (PPM) in women. There are currently no large study comparing the outcomes of men versus women after the Ross procedure.

METHODS AND RESULTS: This study was designed to analyze 10-year clinical and echocardiographic data of men and women who underwent a Ross procedure. Since 2011, 700 patients received a Ross procedure in our institution. Within this cohort, 199 were females (28%). Mean follow-up time is 5.7 ± 3.3 years and does not differ between sex. Mean age was also similar (females: 47±13 vs males: 49±12, p=0.16). Women had a lower rate of dyslipidemia (23% vs 34%, p=0.01). However, there was no difference in the rates of diabetes (p=0.73), hypertension (p=0.40), smoking (p=0.61), and obstructive pulmonary disease (0.21). The proportion of patients presenting for reoperation was also similar between women and men (17% vs 13%, p=0.21). Preoperative ejection fraction was slightly higher in women (61±7% vs 59±8%, p< 0.01). On the other hand, mean aortic gradients (46±18 mm Hg vs 47±19 mm Hg, p=0.39) and valve area (0.9±0.4 cm2 vs 1.0±0.4 cm2, p=0.15) were similar between the 2 groups. Aortic annuli were significantly smaller in women (22±3 mm vs 25±3 mm, p< 0.01). Cardiopulmonary bypass time was similar between the 2 groups (181±47 min vs 188±41 min, p=0.07). The incidence of postoperative complications was similar between women and men. Notably, there was no difference in terms of need for dialysis (p=0.99), occurrence of stroke (p=0.99), heart attack (p=0.99), and need for permanent pacemaker (p=0.99). Importantly, there was no PPM in either group. At 10 years, the cumulative incidence of cardiac reintervention is similar in women and men (3±2% vs 5±2%, p=0.37). Similarly, mean aortic gradient do not differ significantly after 10 years of follow-up (4±2 mm Hg, p=0.27). Survival at 10 years is similar between women and men (98±1% vs 98±1%, p=0.99), even after adjusting for confounding variables.

Conclusion: Women who received a Ross procedure achieved similar results compared to men. Despite smaller aortic annuli preoperatively, women seem to derive the same hemodynamic benefits as their male counterparts at 10 years. These results contrast with several studies exploring the impact of gender on outcomes following aortic valve replacement with a prosthesis.