Female sex was associated with similar 10-year freedom from the primary composite endpoint compared to male sex after elective valve-sparing root replacement (82.8% vs 83.9%, p=0.740).
Cohort (n=1,019)
Yes
Does female sex impact long-term outcomes compared to male sex in patients undergoing elective valve-sparing root replacement?
Despite women presenting at a younger age with more heritable thoracic aortic disease and smaller absolute aortic diameters, long-term outcomes after elective valve-sparing root replacement are equivalent between sexes.
Absolute Event Rate: 82.8% vs 83.9%
p-value: p=0.740
Abstract OBJECTIVES Sex-related disparities are well established in cardiovascular disease, but their impact on outcomes after valve-sparing root replacement (VSRR) is not well defined. In a multicentre international cohort, we evaluated sex-based differences in clinical characteristics, radiographic features and outcomes after elective VSRR. METHODS We retrospectively analysed all patients who underwent VSRR between 2004 and 2024 at three high-volume centres in the United States and Europe. Baseline, operative, and imaging data were compared between sexes. The primary end-point was a composite of all-cause mortality, 30-day cerebrovascular accident, and Zone 0–3 aortic reintervention or aortic valve reintervention. Kaplan–Meier and competing risk analyses were performed, with 4:1 propensity score matching (caliper 0.2) to adjust for baseline imbalances. RESULTS 1’019 patients (191 women, 19%) undergoing VSRR were included in the study. Women were younger (46.7 vs 50.4 years, p = 0.002), more likely to present with heritable thoracic aortic disease (51% vs 17%, p 0.001), and had smaller aortic diameters but larger indexed dimensions compared with men (all p ≤ 0.001). Aortic valve leaflet repair was performed less frequently in women (17% vs 34%, p 0.001). After matching, no significant sex differences were observed in early outcomes. At 10 years, freedom from the composite end-point was similar between women and men (82.8% vs 83.9%, p = 0.740), as were survival (95.0% vs 96.4%, p = 0.920) and cumulative incidences of reintervention or dissection. Age thresholds for adverse events were lower in women (50 years) than in men (59 years). CONCLUSIONS Only one-fifth of VSRR patients were women, who presented younger with more heritable thoracic aortic disease and smaller absolute aortic diameters. Despite these differences, long-term outcomes were equivalent, suggesting that sex alone does not determine surgical results. Earlier surgical referral guided by indexed aortic measurements may improve recognition and outcomes in women.
Yildiz et al. (2026) conducted a cohort in Elective valve-sparing root replacement (n=1,019). Female sex vs. Male sex was evaluated on Composite of all-cause mortality, 30-day cerebrovascular accident, and Zone 0-3 aortic reintervention or aortic valve reintervention (p=0.740). Female sex was associated with similar 10-year freedom from the primary composite endpoint compared to male sex after elective valve-sparing root replacement (82.8% vs 83.9%, p=0.740).