Gender-Related 30-Day and Long-Term Surgical Outcome in Patients with Infective Endocarditis

Objectives: Surgery in patients with infective endocarditis is associated with considerable mortality and it is controversially discussed whether female gender is a risk factor for an even worse outcome. This large study analyzed the impact of gender on morbidity, early and long-term mortality in patients with infective endocarditis.

Methods: This retrospective study included 413 consecutive patients (74.6% male vs. 25.4% female) undergoing surgery for infective endocarditis between January 2002 and February 2020. Univariate and multivariable analyses were conducted to identify potential gender-specific risk factors. Survival was estimated by Kaplan–Meier survival curves.

Result: Women with endocarditis were not significantly older than men (65 vs. 64 years, p = 0.082). In the male group, more patients presented with coronary heart disease (46.3 vs. 34.3%, p = 0.033) and previous endocarditis (16.6 vs. 8.6%, p = 0.045). Male patients presented with a higher portion of aortic valve infection (34.7 vs. 20.0%, p = 0.005), while in the female group more mitral valve infection occurred (29.5 vs. 19.8%, p = 0.039).

Intraoperatively, women received more red blood cell concentrates (4 vs. 2 units, p < 0.001), while men needed postoperative blood transfusion more often (2 units (0–27) vs. 2 units (0–17), p = 0.015). Male patients had a longer postoperative stay (10 vs. 9 days, p = 0.046) and tended to develop a delirium more frequently (18.2 vs. 10.0%, p = 0.054). Thirty-day mortality was significantly higher in the female group (26.7 vs. 14.9%, p = 0.007). Female gender was predictive for 30-day mortality (OR: 2.076), as well as age (OR: 1.028) and preoperative acute or chronic dialysis (OR: 2.754), NYHA stage IV (OR: 3.055), previous cardiac surgery (OR: 2.162), cardiogenic shock (OR 3.946), neurological deficits (OR: 2.976) and abscess (OR: 2.306). Averaged follow-up time was 2.8 (0–16.5) years and total all-cause survival did not differ significantly between genders (log-rank p = 0.103), particularly if it was calculated on the basis of patients who survived 30 days only (p = 0.853).

Conclusion: In our large analysis, female patients had a higher 30-day mortality rate and female sex was an independent predictor for early mortality. However, long-term survival of 30-day survivors was similar in both genders.

Publication History

Article published online:
19 February 2021