Male sex was not associated with a significant difference in the 20-year cumulative incidence of mitral valve reoperation compared to female sex (9.9% vs 10.9%; adjusted HR 0.87, 95% CI 0.72-1.06).
Cohort (n=7,600)
Yes
Does male sex compared to female sex affect the incidence of repeat mitral valve surgery and mortality in patients undergoing mitral valve surgery for mitral regurgitation?
In patients undergoing mitral valve surgery for mitral regurgitation, there are no significant sex-based differences in the adjusted rates of reoperation or in-hospital mortality, though males have a slightly higher adjusted long-term mortality.
Hazard Ratio: 0.87 (95% CI 0.72–1.06)
Absolute Event Rate: 9.9% vs 10.9%
p-value: p=0.25
Abstract Background Previous studies suggest sex-based differences in outcomes following mitral valve surgery for mitral regurgitation (MR) but data on long-term reoperation rates and mortality remain sparse. Purpose To assess sex-based differences in the incidence of repeat mitral valve surgery and mortality following initial and repeat mitral valve surgery for MR. Methods Using nationwide Danish health registries, we included patients aged ≥18 years who underwent mitral valve surgery for MR between January 1st, 1996, and December 31st, 2022. Patients undergoing transcatheter interventions and patients diagnosed with prior or concomitant infective endocarditis were excluded. Three outcomes were assessed; i) the cumulative incidence of mitral valve reoperation, ii) in-hospital mortality, and iii) long-term mortality following both initial and repeat surgery, stratified by sex with a maximal follow-up of 20 years. Statistical analyses included multivariable adjusted logistic regression analysis and Cox regression as well as the Aalen Johansen estimator for computation of the cumulative incidence of reoperation and the reverse Kaplan Meier estimator for mortality. Results A total of 7,600 patients were included (34.5% female, median age 68.2 years; 65.5% male, median age 66.0 years). A higher proportion of male patients underwent mitral valve repair (71.0%) as compared to females (53.0%). No major differences were seen in the burden of comorbidities between sexes. With a median follow-up of 8.3 years, cumulative incidence of mitral valve reoperation over 20 years was 10.9% for females and 9.9% for males (p=0.25), Figure 1A. Adjusted analysis showed no statistically significant difference in reoperation rates between sexes (HR=0.87, 95% CI: 0.72-1.06) with females as reference. No significant interaction was identified by type of valve intervention (repair, bio prosthetic replacement, or mechanical replacement). In-hospital mortality following initial surgery was higher in females (6.8%) than in males (5.2%), with no statistically significant difference in the adjusted analysis (OR=0.99, 95%CI: 0.81-1.22). 20-year mortality was 72.6% in females and 65.7% in males, (Figure 1B). Adjusted analysis revealed the reverse association with a higher associated rate of mortality in males as compared to females (HR=1.09, 95% CI: 1.01-1.18). In-hospital mortality after repeat surgery (N=450) did not differ significantly between sexes (females: 5.4%, males: 5.3%; p=0.97). Conclusions Patients who underwent mitral valve surgery for mitral regurgitation, the cumulative incidence of reoperation was approximately 10% 20 years postoperatively for both sexes with a median follow-up of 8.3 years. While in-hospital and long-term mortality rates were higher in females, adjusted analyses revealed no significant sex-based differences.
Koeber et al. (2025) conducted a cohort in Mitral regurgitation (n=7,600). Male sex vs. Female sex was evaluated on Cumulative incidence of mitral valve reoperation over 20 years (HR 0.87, 95% CI 0.72-1.06, p=0.25). Male sex was not associated with a significant difference in the 20-year cumulative incidence of mitral valve reoperation compared to female sex (9.9% vs 10.9%; adjusted HR 0.87, 95% CI 0.72-1.06).