Abstract 4359916: Sex and Age Influence Surgical Aortic Valve Prosthesis Type in Very Young Adults

Abstract

Background: Aortic valve prosthesis selection is complex for very young adults. We aimed to determine whether type of aortic valve prosthesis (mechanical vs. bioprosthetic vs. Ross) differs by sex in this population and explore variables influencing valve type. Hypothesis: We hypothesize that young women of child-bearing age undergo non-mechanical aortic valve replacement (AVR). Methods: Single center retrospective cohort study of 509 patients aged 18-45 who underwent surgical AVR between 2002-2023. Thirty-six patients who underwent concomitant mechanical valve in the mitral position were excluded from regression models as all 36 patients underwent mechanical aortic valve replacement. Outcome measure was defined as non-mechanical (bioprosthetic or Ross) aortic valve prosthesis. Demographic and clinical variables that may influence prosthesis type were compared by sex ( Table 1 ). Age was dichotomized into younger (18-34 years) and older (35-45 years). Multivariable logistic regression was performed to test the association between sex and non-mechanical AVR, accounting for variables that may also influence prosthesis selection ( Table 2 ). We modeled an interaction between age and sex to test our hypothesis. Results: Overall valve replacement strategies included: 246 patients (48%) bioprosthetic, 221 (43%) mechanical, and 42 (8.3%) Ross procedure. Patient characteristics compared by sex are reported in Table 1 . Females were overall less likely to undergo non-mechanical prosthesis compared to males (OR=0.49, 95% CI [0.28, 0.87], p-value = 0.014). Younger females (age 18-34) were more likely than older females (age 35-45) to undergo non-mechanical prosthesis (OR=2.31, 95% CI [1.09, 5.02], p-value = 0.032), while younger males (age 18-34) were less likely than older males (age 35-45) to undergo non-mechanical prosthesis (OR: 0.49, 95% CI [0.30,0.79], p-value = 0.003) ( Table 2 ). Conclusion: Sex differences in type of valve prosthesis exist for very young adults undergoing AVR. Though females overall had lower odds of undergoing non-mechanical AVR compared to males, youngest females underwent non-mechanical AVR at an overwhelmingly high rate in comparison to males and older females.