Purpose: This study explored the sex differences in the outcomes of degenerative mitral valve repair (MVr). Methods: From 2010 to 2019, 1069 patients who underwent MVr due to degenerative mitral disease at Beijing Anzhen Hospital were analyzed. The average patient follow-up was 5.1 years (interquartile range: 5–7 years). The primary endpoint was overall survival. Secondary endpoints were freedom from reoperation and recurrent mitral regurgitation. A propensity-matched analysis was used to compare the outcomes of males and females. Results: Females were older, had a higher prevalence of atrial fibrillation and moderate-to-severe tricuspid regurgitation, and had smaller left atrial, left ventricular end-diastolic, and left ventricular end-systolic diameters. Males were more likely to undergo concomitant coronary artery bypass grafting and had longer cardiopulmonary bypass and aortic cross-clamp times. The in-hospital mortality was <1% (10/1,069). After propensity score matching of 331 pairs of patients, most variables were well balanced. Before and after propensity score matching, the long-term survival and freedom from reoperation rates were similar. Males had higher durability after surgery compared with females. Conclusions: Females were referred to surgery later and had more complications than males. Long-term survival and freedom from reoperation rates were not significantly different between the sexes.

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Background For patients with giant left atria, outcomes of surgical ablation remain controversial. We aimed to compare the efficacy of radiofrequency ablation between patients undergoing mitral valve surgery with and without giant left atria. Methods This retrospective, single-center, cohort study investigated patients who underwent mitral valve surgery and concomitant radiofrequency ablation from 2009 to 2019. Patients were divided into non-giant left atria (diameter ≤65 mm, n=1,543) and giant left atria (diameter >65 mm, n=241) groups. Five-year freedom from atrial tachyarrhythmia recurrence and thromboembolic event rates were assessed with death as the competing risk factor with and without propensity-score matching. Results Patients with giant left atria had higher mortality (10.8% versus 6.2%, P=0.008) and readmission rates for heart failure than those without (12.0% versus 6.8%, P=0.004). Atrial tachyarrhythmia recurrence rates were higher in patients with giant left atria than those without (49% versus 24% at 5 years, P<0.001), but the cumulative incidence of thromboembolic events before (P=0.944) and after (P=0.695) propensity-score matching were comparable. Conclusions Radiofrequency ablation effectively prevented thromboembolic events in patients with giant left atria, despite significant atrial tachyarrhythmia recurrence. Atrial tachyarrhythmia recurrence did not increase the risk of thromboembolic events. A lower success rate should be considered when deciding whether to perform surgical ablation in patients with giant left atria.