SURGERY FOR AORTIC REGURGITATION IN WOMEN - CONTRASTING INDICATIONS AND OUTCOMES COMPARED WITH MEN

Background Indications for surgical correction of aortic regurgitation have been established mostly in men and have not been validated in wo men. The outcome of this surgical correction in women is unknown. Meth ods and Results Baseline characteristics and postoperative outcomes we re compared between 51 women and 198 men undergoing surgery for isolat ed aortic regurgitation between 1980 and 1989. Compared with men, wome n had surgery rarely for severe left ventricular enlargement (systolic diameter greater than or equal to 55 mm in 11% versus 27%, P=.031; di astolic diameter greater than or equal to 80 mm in 0% versus 16%, P<.0 001) and more often for class III to IV symptoms (59% versus 32%, P<.0 001). Operative mortalities were similar in women and men (3.9% and 4. 5%, respectively). Among operative survivors, 10-year survival was wor se for women than for men (39+/-9% versus 72+/-4%, P=.0002) and, in co ntrast with men, was worse than expected for women (P<.0001). Independ ent predictors of late survival were different for men (age and ejecti on fraction) and women (age and concomitant coronary bypass grafting). By multivariate analysis, female sex was an independent predictor of worse late survival (adjusted relative risk, 1.80; 95% CI, 1.04 to 3.1 1). Conclusions The generalization to women of the unadjusted left ven tricular diameter surgical criteria established in men results in irre levant criteria almost never reached in women, who often undergo surge ry after developing severe symptoms. After surgery, women exhibit an e xcess late mortality, suggesting that surgical correction of aortic re gurgitation should be considered at an earlier stage in women.