Key result
Female sex is linked to an absolute ~5% higher 15-year survival after endocarditis valve surgery.
Why the study?
Female patients with IE are referred to surgery less often than males, and research on sex differences after IE surgery is inconclusive.
Does female sex affect net survival and loss of life expectancy in patients undergoing aortic valve surgery for infective endocarditis?
Cohort (n=2,585)
Yes
Does female sex affect net survival and loss of life expectancy in patients undergoing aortic valve surgery for infective endocarditis?
Although women presenting with infective endocarditis who undergo aortic valve surgery tend to be older and have more comorbidities, they exhibit a slightly higher adjusted net survival compared to men, suggesting that surgery is well-tolerated and should not be deferred based on female sex.
Women had higher adjusted survival after aortic valve surgery for infective endocarditis; supports equitable referral but leaves mechanisms and practice change open.
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.
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Bearpark et al. (2026) conducted a cohort in Infective endocarditis (n=2,585). Female sex vs. Male sex was evaluated on Adjusted 15-year all-cause mortality (cumulative incidence) (ARR 4.5%, 95% CI 0.5-8.5). After accounting for baseline differences, female patients had a 4.5% higher estimated survival at 15 years compared to male patients following aortic valve surgery for infective endocarditis.
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