Predictors of Long-Term Clinical Outcomes of Perceval Aortic Valve Replacements in Females: A 9-Year Experience

Background: Females are at increased risk of patient–prosthesis mismatch (PPM) following surgical aortic valve replacement (AVR) due to anatomical complexities. Whilst sutureless valves can reduce risk in smaller annuli, the literature lacks sex-specific outcome data pertaining to women. We evaluate long-term survival and durability outcomes pertaining to females. Methods: This is a retrospective analysis of demographic, clinical and outcome data in adults undergoing first-time isolated Perceval sutureless AVR between January 2017 and June 2025 at a tertiary centre. Subgroup analysis in females was also performed. Results: The number of patients N = 430 (178 males, 252 females). The median follow-up was 4.5 years. Females had higher Euroscores (p = 0.03) and smaller prosthetic valves (p = 0.01), but this group had fewer individuals with diabetes (p = 0.02) and fewer smokers (p < 0.01). Females had a higher 9-year survival (p = 0.02), where Euroscore (p = 0.02) and angina (p = 0.03) conferred a worse survival. No patients had PPM. FFR at 9 years was 97.3% in females (p = 0.61 compared to males); there were three reinterventions due to paravalvular leak. Of the females studied, 7.5% had permanent pacemakers at 9 years, with no significant predictors. At 9 years 2.4% of females had a stroke admission (mean time 1.4 ± 0.8 years), and female gender predicted stroke admission (p = 0.04). At 9 years, 3.1% had heart-failure admissions (mean time 1.8 ± 0.6 years), where angina (p = 0.02) predicted heart-failure admissions in females. Conclusion: The findings in our single-centre retrospective cohort study suggest excellent long-term survival and durability outcomes in females, however, with a greater predisposition to stroke admissions after discharge. Whilst optimization of pre-operative symptoms can potentially reduce adverse events, further larger, non-inferiority studies with echocardiographic data are required to validate our findings.