Sex does not influence outcomes in valvular heart surgery due to infective endocarditis: A systematic review and meta-analysis

This systematic review and meta-analysis aimed to evaluate sex-based differences in surgical outcomes among patients with infective endocarditis (IE). A comprehensive search of three major medical databases identified ten studies encompassing 16,763 patients who underwent valvular surgery for IE. Of these, 70.8% were male (<i>n</i> = 11,873), and 29.2% were female (<i>n</i> = 4890). Female patients were generally older at the time of surgery. The most common causative pathogen was <i>Staphylococcus aureus</i> (28.4%), followed by <i>Streptococcus</i> (22.5%) and <i>Enterococcus</i> (4.1%). Females demonstrated lower aortic valve involvement (risk ratio [RR]: 0.80, 95% confidence interval [CI]: 0.67-0.96) but higher mitral valve involvement (RR: 1.30, 95% CI: 1.17-1.45, <i>p</i> < 0.001). They also had a reduced prevalence of <i>Streptococcus</i> (RR: 0.89, 95% CI: 0.81-0.98, <i>p</i> = 0.02) and <i>Enterococcus</i> (RR: 0.71, 95% CI: 0.62-0.82, <i>p</i> = 0.03) infections and a lower risk of abscess formation (RR: 0.87, 95% CI: 0.76-0.99, <i>p</i> = 0.03) compared to males. There was a significant difference in the in-hospital mortality between female and male patients (RR: 1.30, 95% CI: 1.04-1.61, <i>p</i> = 0.02). No significant sex-related differences were observed in the duration of hospitalization. However, significant sex-related differences were observed in the incidence of postoperative stroke (RR: 1.10, 95% CI: 1.02-1.20, <i>p</i> = 0.02). In summary, female patients undergoing surgery for IE face a higher risk of both in-hospital mortality and postoperative stroke compared to males, underscoring clinically meaningful sex-based disparities in short-term surgical outcomes. These findings emphasize the need for further studies to clarify these observations. (PROSPERO Registration: CRD42024602013).