Unfavorable impact of female gender on outcomes following aortic valve replacement combined with coronary artery bypass grafting

Despite widespread implementation of intravascular techniques in cardiovascular medicine, combined aortic valve replacement (AVR) and coronary artery bypass grafting (CABG) have still been standard of surgical treatment. A purpose of this multicenter retrospective cohort study was to assess an impact of female sex on early outcomes and late survival rate following simultaneous AVR + CABG. This study comprised 12,626 patients (30.1% females; 69.9% males) that underwent AVR + CABG in 2006 through 2020. Primary endpoint was late survival. Thirty-day mortality and morbidity rates were also evaluated. In order to reduce an impact of inherent confounders, a propensity score (PS) matching was applied. PS matching selected 3,443 pairs and both gender groups were well balanced for baseline and operative characteristics. Women had higher 30-day mortality (OR: 1.42 (1.17-1.73), p < 0.001), more prevalent respiratory failure (OR: 1.28 (1.06-1.55), p = 0.01) and increased risk of postoperative application of cardiac support devices (OR: 1.46 (1.09-1.94), p = 0.01), but reduced incidence of re-thoracotomy due to bleeding compared to men (OR: 0.8 (0.67-0.95), p = 0.01). A probability of survival of 4-year (76.2 vs. 76.1%) and 8-year (58.8 vs. 57.0%) follow-up was comparable between females and males, respectively. Women undergoing aortic valve replacement with concomitant artery bypass grafting presented worse early outcomes but comparable long-term survival to men.