Key result
Female sex shows no difference in long-term mortality after mitral valve surgery versus males.
Why the study?
Sex-related differences in the presentation and outcomes of patients with mitral regurgitation undergoing mitral valve surgery remain unclear.
Does female sex affect long-term all-cause mortality and post-operative length of stay compared to male sex in patients undergoing mitral valve surgery for mitral regurgitation?
Cohort (n=143)
No
Does female sex affect long-term all-cause mortality and post-operative length of stay compared to male sex in patients undergoing mitral valve surgery for mitral regurgitation?
Answers are grounded in this paper and cite their sources.
Although women present with more advanced symptoms and smaller unindexed LV dimensions prior to mitral valve surgery, their long-term survival is comparable to propensity-matched men, highlighting the need for BSA-indexed or sex-specific surgical referral thresholds.
Background/Objectives: Sex-related differences in the presentation and outcomes of patients with mitral regurgitation (MR) undergoing mitral valve (MV) surgery remain unclear. We aimed to identify these differences to inform personalized management. Methods: A total of 143 consecutive patients undergoing surgery for MR between 2017 and 2018 were stratified by sex and assessed for differences in characteristics. We performed 1:1 propensity score matching (PSM) by sex, with baseline characteristics as covariates, yielding 38 comparable pairs which were analyzed for differences in all-cause mortality and post-operative length of stay (LOS). Results: Females (n = 67) were more symptomatic (NYHA Class ≥ 3: 73% vs. 45%, p < 0.001), had higher logistic EuroSCORE (5.5 vs. 3.9, p = 0.006), had more urgent operations (25% vs. 11%, p = 0.020), MV replacements (28% vs. 11%, p = 0.007), and secondary MR (43% vs. 16%, p < 0.001). Females had significantly smaller end-diastolic and end-systolic left ventricular (LV) diameters, though indexed diameters showed no significant differences. After PSM, females had significantly longer LOS (7 days vs. 9 days, p = 0.033) and no differences in long-term mortality (hazard ratio [HR]: 1.25, 95% confidence interval [CI]: 0.34–4.76, p = 0.7, median follow-up: 6.67 years). An indexed LV end-systolic diameter (LVESDi) > 19 mm/m2 yielded greater specificity (46.0% vs. 26.7%) and comparable sensitivity (69.4% vs. 69.2%) to LVESD > 40 mm. In subgroup analyses, female patients undergoing concomitant tricuspid intervention (HR: 6.80 [1.63–37.92], p < 0.01) or urgent operation (HR: 4.85 [1.08–21.06], p = 0.04) had worse prognoses than males. Conclusions: Females undergoing MV surgery for MR had more symptoms, higher surgical risk, and longer LOS, but similar mortality compared to males. However, concomitant tricuspid intervention and urgent operations were associated with higher mortality. Our results add to the growing body of evidence that current non-indexed LV diameter thresholds may not adequately account for sex differences.
No takes yet. Share an insight, caveat, or question.
Long et al. (2025) conducted a cohort in Primary and secondary mitral regurgitation undergoing mitral valve surgery (n=143). Female sex vs. Male sex (propensity score-matched 1:1) was evaluated on All-cause mortality (in propensity score-matched cohort) (HR 1.25, 95% CI 0.34-4.76, p=0.7). Female sex was not associated with a significant difference in long-term all-cause mortality after mitral valve surgery compared to propensity-matched males (HR 1.25, 95% CI 0.34-4.76, p=0.7).
Synapse has enriched 10 related papers. Consider them for comparative context: