June 16, 2026Journal of the American Heart Association0 citationsOpen Access
View Full PaperSex Differences in Clinical Outcomes and Loss of Life Expectancy After Aortic Valve Surgery for Infective Endocarditis: A SWEDEHEART Study
Key Result
Female sex was associated with higher net survival compared with male sex after aortic valve surgery for infective endocarditis, despite a higher crude mortality rate (49% vs 41%).
Key Points
- This research aims to understand the influence of sex on clinical outcomes and loss of life expectancy following aortic valve surgery for infective endocarditis.
- Conducted a population-based observational study from 1997 to 2022 in Sweden.
- Included all patients undergoing aortic valve surgery for infective endocarditis, totaling 2585 patients, with data sourced from national registers.
- Utilized flexible parametric models to assess net survival and calculate loss of life expectancy.
- Among patients, 19% were female, with women having a higher median age and more comorbidities.
- During follow-up, 49% of female patients died compared to 41% of male patients, indicating a trend in survival rates.
- Loss of life expectancy was pronounced, particularly in younger patients, with 15.5 years for a 50-year-old female versus 2.1 years for an 80-year-old male.
Study Design
Type
Cohort (n=2,585)
Multicenter
Yes
Structured PICO
Does female sex impact loss of life expectancy and net survival compared to male sex in patients undergoing aortic valve surgery for infective endocarditis?
P
Population
2,585 patients (19% female) undergoing aortic valve surgery for infective endocarditis in Sweden, followed for a mean of 7 years.
E
Exposure
Female sex
C
Comparator
Male sex
O
Outcome
Loss of life expectancy and net survivalhard clinical
After aortic valve surgery for infective endocarditis, women have higher net survival than men after accounting for baseline differences, though both sexes experience considerable loss of life expectancy.
Main Result
Absolute Event Rate: 49% vs 41%
Abstract
BACKGROUND: Female patients with infective endocarditis (IE) are referred to surgery less often than male patients, and research on sex differences after IE surgery is inconclusive. Understanding the impact of sex can help clinicians optimize patient care. Therefore, we investigated sex-based differences in loss of life expectancy and net survival after aortic valve surgery for IE. METHODS: We conducted a population-based, observational cohort study, including all patients undergoing aortic valve surgery for IE in Sweden from 1997 to 2022. Data came from national registers, including SWEDEHEART (Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart-Disease Evaluated According to Recommended Therapies). Loss of life expectancy and net survival were calculated based on population data from the Human Mortality Database. Flexible parametric models were used to assess net survival. RESULTS: A total of 2585 patients underwent aortic valve surgery for IE; 19% were female. Women were older than men (median age 66 versus 63) and had more concomitant valve surgery and comorbidities, as well as lower socioeconomic status. During a mean follow-up of 7 years, 245 female patients (49%) versus 857 male patients (41%) died. Loss of life expectancy was accentuated in younger patients, ranging from 15.5 years (95% CI, 9.0-21.9) in a 50-year-old female to 2.1 years (95% CI, 0.95-3.2) in an 80-year-old male. After regression standardization, women had higher net survival compared with men. CONCLUSIONS: After aortic valve surgery for IE, net survival was higher among female patients after accounting for baseline differences, and loss of life expectancy was considerable for both female and male patients, particularly in younger patients. Focus on early diagnosis, as well as optimized pre- and postoperative care, is essential in patients with IE.