PMID- 7955249
OWN - NLM
STAT- MEDLINE
DCOM- 19941209
LR  - 20061115
IS  - 0009-7322 (Print)
IS  - 0009-7322 (Linking)
VI  - 90
IP  - 5 Pt 2
DP  - 1994 Nov
TI  - Gender differences in left ventricular functional response to aortic valve 
      replacement.
PG  - II183-9
AB  - BACKGROUND: To characterize gender differences in recovery of ventricular 
      function and survival after aortic valve replacement (AVR), baseline 
      characteristics related to outcome were analyzed in 1012 consecutive patients 
      (329 women and 683 men) undergoing AVR in 1983 through 1990. METHODS AND RESULTS: 
      Seventy-seven percent of patients had aortic stenosis (AS), 11% insufficiency 
      (AI), and 12% mixed AS/AI; 42% underwent concomitant coronary artery bypass. 
      Women as a group had a greater mean age (P < .0001), had AS more frequently than 
      AI or AS/AI (P < .01), had coronary disease less frequently (P < .01), and had a 
      higher preoperative left ventricular ejection fraction (EF) (P < .0001), although 
      preoperative New York Heart Association (NYHA) functional class was similar (P = 
      NS) compared with men. Male sex (P < .0001), advanced age (P < .0003), AI rather 
      than AS (P < .01), and greater extent of coronary disease (P < .04) were 
      independently associated with lower preoperative EF. Women with coronary disease 
      were as likely as men (P = NS) to undergo concomitant coronary bypass, and 
      completeness of revascularization did not differ (P = NS) by gender. Observed 
      survival probabilities after AVR (expressed as 30-day/5-year) were .97/.81 
      overall, .94/.77 for women, and .98/.83 for men (P < .02). Cox model analysis 
      showed advanced age, decreased preoperative EF, greater extent of coronary 
      disease, requirement for annular enlargement, smaller prosthetic valve size, and 
      advanced NYHA class (all P < .04) but neither female sex nor smaller body surface 
      area (both P = NS) as multivariate risk factors for overall mortality. In 664 
      patients (66%), postoperative EF was measured a mean 1.4 years after AVR. In 
      patients with preoperative EF < or = 45% (n = 167), the change in EF after AVR 
      was greater (P < .02) in women (from 33 +/- 8% to 48 +/- 15%, P < .001) than in 
      men (from 32 +/- 9% to 42 +/- 15%, P < .001). By multivariate regression 
      analysis, female sex (P < .02) and lesser extent of coronary disease (P < .05) 
      were independent predictors of early improvement in EF. Improvement in EF 
      conveyed an independent subsequent survival benefit to both women (P < .03) and 
      men (P < .001), and the magnitude of benefit did not differ (P = .4) between the 
      two groups. CONCLUSIONS: These data suggest that gender-related factors 
      importantly influence the adaptive and recovery response of the left ventricle to 
      pressure and volume overload. However, gender differences in LV adaptation do not 
      influence survival after AVR.
FAU - Morris, J J
AU  - Morris JJ
AD  - Division of Thoracic and Cardiovascular Surgery, Mayo Clinic, Rochester, MN 
      55905.
FAU - Schaff, H V
AU  - Schaff HV
FAU - Mullany, C J
AU  - Mullany CJ
FAU - Morris, P B
AU  - Morris PB
FAU - Frye, R L
AU  - Frye RL
FAU - Orszulak, T A
AU  - Orszulak TA
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - United States
TA  - Circulation
JT  - Circulation
JID - 0147763
SB  - IM
MH  - Aged
MH  - Aortic Valve
MH  - Aortic Valve Insufficiency/epidemiology/physiopathology/*surgery
MH  - Aortic Valve Stenosis/epidemiology/physiopathology/*surgery
MH  - Coronary Artery Bypass
MH  - Coronary Disease/epidemiology/surgery
MH  - Female
MH  - Follow-Up Studies
MH  - *Heart Valve Prosthesis
MH  - Humans
MH  - Male
MH  - Regression Analysis
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Sex Factors
MH  - Stroke Volume/physiology
MH  - Survival Analysis
MH  - Time Factors
MH  - Treatment Outcome
MH  - Ventricular Function, Left/*physiology
EDAT- 1994/11/01 00:00
MHDA- 1994/11/01 00:01
CRDT- 1994/11/01 00:00
PHST- 1994/11/01 00:00 [pubmed]
PHST- 1994/11/01 00:01 [medline]
PHST- 1994/11/01 00:00 [entrez]
PST - ppublish
SO  - Circulation. 1994 Nov;90(5 Pt 2):II183-9.