Sex-based differences after aortic valve surgery for infective endocarditis: a SWEDEHEART study

Background Female patients with infective endocarditis (IE) are referred to surgery less often than their male counterparts and research on sex-based differences in outcomes after IE surgery is inconclusive. Purpose The purpose of our study was to examine clinical outcomes and life expectancy after aortic valve surgery for IE in female versus male patients. Methods We performed a nationwide, observational cohort study including all patients who underwent aortic valve surgery for IE in Sweden between 1997 and 2022. Data was sourced from SWEDEHEART and other national health registers. The primary outcomes were all-cause mortality and loss of life expectancy. The secondary outcomes were heart failure, and recurrent IE. Flexible parametric models were used for multivariable adjustment. Results Of 2102 patients who underwent aortic valve surgery for IE, 385 (18%) were female. At the time of surgery, females were older than males (66 vs. 63 years), had more concomitant valve surgery, more comorbidities, and worse socioeconomic status. Crude survival was lower among female than male patients (figure 1). At 15 years of follow-up, the cumulative incidence of all-cause mortality was 54% among females and 58% among males, after multivariable adjustments (absolute risk difference: 4.0%, 95% CI –0.7 to 8.8). The median loss of life expectancy was 5.2 years for females and 4.1 years for males. Loss of life expectancy was more pronounced in younger age groups; it ranged from a median of 10.8 and 8.8 years, respectively, among female and male patients below 46 years old (p = 0.05), to 2.6 and 1.7 years, respectively, for female and male patients above 75 years old (p < 0.01). Conclusions After adjustment for older age and more comorbidities at the time of surgery, there was no difference in all-cause mortality between female and male patients after aortic valve surgery for IE. Despite medical advances, this study confirms that IE results in considerable loss of life expectancy for both sexes, especially in younger patients.