Impact of sex on long-term outcomes following mitral valve repair

EL‐Andari, Ryaan; Bozso, Sabin J.; Kang, Jimmy J H; Boe, Dana; Fialka, Nicholas M.; Hong, Yongzhe; Moon, Michael; Freed, Darren H.; Nagendran, Jayan; Nagendran, Jeevan

doi:10.1016/j.ahjo.2021.100004

Cited by 4 publications

(21 citation statements)

References 22 publications

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“…The 30-day mortality was reported in four studies and ranged from 0% to 9.1% for males and 0% to 15.1% for females with no significant differences between the groups. 5,20,21 Pooled estimates of 30-day mortality were not significantly different with an OR of 0.70 and 95% CI of 0.39–1.26, z-score = 1.18, p = 0.24 (Fig. 2B).…”

Section: Resultsmentioning

confidence: 90%

“…Five studies included reoperation rates post MV surgery with no significant differences between males and females. 5,20 – 22,24 Pooled estimates of reoperation rates were not significantly different with an OR of 0.77 and 95% CI of 0.49–1.22, z-score = 1.11, p = 0.27 (Fig. 3B).…”

Section: Resultsmentioning

confidence: 91%

“…Included study types were retrospective and prospective studies. In all, four studies included propensity matching 20,21,23,24 while eight did not. Among studies that did not propensity match patients, Giustino et al.…”

Section: Resultsmentioning

confidence: 99%

“…Five studies reported postoperative stroke rates after MV surgery. 5,20 – 22,24 One study reported significant differences between the two groups with males exhibiting 2.1% postoperative stroke rates while females had 3.7% (p = 0.022). 24 Pooled estimates of postoperative stroke rates did not differ significantly with an OR of 1.11 and 95% CI of 0.61–2.02, z-score = 0.34, p = 0.74 (Fig.…”

Section: Resultsmentioning

confidence: 99%

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Does sex impact outcomes after mitral valve surgery? A systematic review and meta-analysis

et al. 2022

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Background and objective: The published literature investigating the impact of sex on outcomes after mitral valve (MV) surgery has demonstrated inferior outcomes for females over males. However, the true relationship between sex and outcomes after MV surgery continues to be poorly understood. Materials: PubMed, Medline, and Embase were systematically searched for articles published from 1 January 2005 to 1 August 2021. This systematic review included retrospective and prospective studies investigating the relationship between sex and outcomes after MV surgery. In all, 2068 articles were initially screened and 12 studies were included in this review. Results: Few studies were adequately powered or structured to investigate this topic. Few studies propensity matched patients or isolated for surgical approach. In individual studies, females experienced increased rates of short-term and long-term mortality and increased 1-year mortality in the pooled data. Males experienced increased rates of required pacemaker insertion. The remaining rates of morbidity and mortality did not differ significantly between males and females. Conclusions: This review identified increased rates of 1-year mortality in the pooled data for females, while males had increased rates of pacemaker insertion. Despite this, the absence of propensity matching and isolating for surgical approach has introduced confounding variables that impair the ability of the included studies to interpret the results found in the current literature. Studies isolating for surgical approach, propensity matching patients, and examining outcomes with long-term follow-up are required to elucidate the true nature of this relationship.

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Section: Resultsmentioning

confidence: 90%

Section: Resultsmentioning

confidence: 91%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Does sex impact outcomes after mitral valve surgery? A systematic review and meta-analysis

et al. 2022

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“…In both studies, males and females had equivalent survival and postoperative outcomes. In cases where there were significant differences, such as postoperative MI or sepsis after MVR, it was males that had the inferior outcomes [33, 34]. With relatively few studies propensity matching patients and isolating for surgical approach, it is difficult to determine whether it is the treatment patients receive or sex itself that is a risk factor for inferior outcomes.…”

Section: Discussionmentioning

confidence: 99%

Sex-Related Differences in Transcatheter Mitral Valve Repair: A Systematic Review and Meta-Analysis

et al. 2022

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Objective: Inequalities in postoperative outcomes between males and females are well described with females often experiencing inferior outcomes after heart valve surgery. Recent literature has demonstrated equivalent or improved outcomes for females after transcatheter aortic valve replacement. Transcatheter mitral valve repair (TMVr) and replacement (TMVR) is a relatively newer field with significantly less literature comparing sex differences. This systematic review and meta-analysis looks to provide a comprehensive summary of the published literature comparing outcomes between males and females undergoing transcatheter MV interventions. Methods: PubMed, Medline, and Scopus were systematically searched for all studies comparing outcomes between males and females undergoing TMVr and TMVR. 2,178 English manuscript titles and abstracts were reviewed. Articles were excluded if data was not provided regarding sex differences, transcatheter MV intervention, full-length text was not accessible, or if insufficient data was provided. 2,170 articles were excluded and 8 articles were included in this study. Results: Pooled estimates of outcomes demonstrated rates of acute kidney injury [OR 1.28 (95% CI, 1.14-1.44; p<0.0001)] favored females while rates of major bleeding favored males [OR 0.85 (95% CI 0.76-0.96; p=0.01)]. Rates of mortality, postoperative MI, and stroke did not differ significantly. Conclusion: A trend has emerged in heart valve interventions with males tending to have improved outcomes after surgical intervention and females experiencing equivalent or improved outcomes after transcatheter interventions. This meta-analysis identified increased rates of acute kidney injury for males, increased rates of major bleeding for females, and otherwise comparable morbidity and mortality in males and females undergoing TMVr.

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Gender Differences in 381 Patients Undergoing Isolated Mitral Regurgitation Repair

Cheng,

Ma,

Zeng

et al. 2024

Thorac Cardiovasc Surg

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Objectives To compare the gender differences in isolated mitral regurgitation (MR) repair. Methods Of 381 adults aged 54.8±12.3 years undergoing mitral valve repair (MVP) for isolated MR from 01/2019-12/2022, the baseline and operative data, and outcomes were compared between 161 women (42.3%) and 220 men (57.7%). Results Women tended to be non-smoker (98.1% vs 45%, P<0.001), and have more cerebrovascular accidents (38.5% vs 24.1%, P=0.004), lower creatinine (70.0±19.5 vs 86.3±19.9 µmol/dL, P<0.001), smaller LVEDD (54.4±6.7 vs 57.8±6.6 mm, P<0.001) and isolated annular dilatation (19.3% vs 9.1%, P=0.010). One female died of stroke at 2 days (0.3%). Another female (0.3%) underwent MV replacement for failed repair. Stroke occurred in 4 (1.0%). Two underwent re-exploration for bleeding (0.5%). Women were more likely to have less 24-hour drainage (290±143 vs 385±196 mL, P<0.001). Over a mean follow-up of 2.1±1.1 years (100% complete), one woman died, one man underwent a reoperation; 28 had moderate MR, and 9 had severe MR. Neither did early and late mortality and reoperation, nor freedom from late moderate/severe MR (71.6% vs 71.4% at 5 years; P=0.992) differ significantly between two genders. Predictors for late moderate/severe MR were anterior leaflet prolapse (hazard ratio [HR] 4.45; 95% confidence interval [CI] 1.18-16.72; P=0.027) and isolated annular dilation (HR 5.47, 95% CI 1.29-23.25; P=0.021). Conclusions Despite significant differences in smoking, cerebrovascular accidents, creatinine, LVEDD, and isolated annular dilatation at baseline, and 24-hour drainage, women and men did not show significant difference in early and late survival, reoperation and freedom from late moderate/severe MR.

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Impact of sex on long-term outcomes following mitral valve repair

Cited by 4 publications

References 22 publications

Does sex impact outcomes after mitral valve surgery? A systematic review and meta-analysis

Does sex impact outcomes after mitral valve surgery? A systematic review and meta-analysis

Sex-Related Differences in Transcatheter Mitral Valve Repair: A Systematic Review and Meta-Analysis

Gender Differences in 381 Patients Undergoing Isolated Mitral Regurgitation Repair

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