Presentation and outcomes of women and men undergoing surgery for degenerative mitral regurgitation

• Published in: European journal of cardio-thoracic surgery Vol. 66; no. 3
• Main Authors: van Kampen, Antonia, Butte, Sophie, Paneitz, Dane C, Nagata, Yasufumi, Langer, Nathaniel B, Borger, Michael A, D’Alessandro, David A, Sundt, Thoralf M, Melnitchouk, Serguei
• Format: Journal Article
• Language: English
• Published: Germany Oxford University Press 02.09.2024
• Subjects: Aged; Echocardiography; Female; Heart Valve Prosthesis Implantation - methods; Heart Valve Prosthesis Implantation - mortality; Heart Valve Prosthesis Implantation - statistics & numerical data; Humans; Male; Middle Aged; Mitral Valve - diagnostic imaging; Mitral Valve - surgery; Mitral Valve Insufficiency - surgery; Postoperative Complications - epidemiology; Retrospective Studies; Sex Factors; Treatment Outcome; Sex disparities; Mitral valve repair; Cardiac surgery guidelines; Surgical timing; Degenerative mitral regurgitation; Gender-specific surgery
• ISSN: 1873-734X; 1873-734X
• DOI: 10.1093/ejcts/ezae312

Abstract OBJECTIVES Degenerative mitral regurgitation is associated with heart failure, arrhythmia and mortality. The impact of sex on timing of surgical referral and outcomes has not been reported comprehensively. We examined preoperative status and surgical outcomes of male versus female degenerative mitral valve regurgitation patients undergoing surgery. METHODS We reviewed our institutional database for all patients undergoing surgery for degenerative mitral regurgitation between 2013 and 2021. Preoperative clinical and echocardiographic variables, surgical characteristics and outcomes were compared, and left atrial strain in available images. RESULTS Of 963 patients, 314 (32.6%) were female. Women were older (67 vs 64 years, P = 0.031) and more often had bileaflet prolapse (19.4% vs 13.8%, P = 0.028), mitral annular calcification (12.1% vs 5.4%, P < 0.001) and tricuspid regurgitation (TR; 31.8% vs 22.5%, P = 0.001). Indexed left ventricular end-diastolic and end-systolic diameters were higher in women, with 29.4 vs 26.7 mm/m2 (P < 0.001) and 18.2 vs 17 mm/m2 (P < 0.001), respectively, and left atrial conduit strain lower (17.6% vs, 21.2%, P = 0.001). Predicted risk of mortality was 0.73% vs 0.54% in men (P = 0.023). Women required mechanical circulatory support more frequently (1.3% vs 0%, P = 0.011), had longer intensive care unit stay (29 vs 26 h, P < 0.001), mechanical ventilation (5.4 vs 5 h, P = 0.036), and overall hospitalization (7 vs 6 days, P < 0.001). There was no difference in long-term reoperation-free survival (P = 0.35). CONCLUSIONS Women undergoing mitral valve repair are older and show indicators of more advanced disease with long-standing left ventricular impairment. Guidelines may need to be adjusted and address this disparity, to improve postoperative recovery times and outcomes. Degenerative mitral valve regurgitation (DMR) is associated with heart failure, cardiac arrhythmias and overall reduced long-term prognosis [1]. Graphical Abstract