Key result
Male sex was independently associated with higher in-hospital mortality compared to female sex after bioprosthetic surgical mitral valve replacement (OR 1.28).
Why the study?
Mitral valve disease is a common cause of heart failure and leading cause of morbidity and mortality, prompting investigation into sex-specific incidence trends and outcomes after surgical mitral valve replacement.
Does sex influence in-hospital mortality and MACCE in patients undergoing surgical mitral valve replacement?
Cohort (n=44,340)
Yes
Does sex influence in-hospital mortality and MACCE in patients undergoing surgical mitral valve replacement?
Odds Ratio: 1.28 (95% CI 1.1–1.5)
Absolute Event Rate: 16% vs 14%
p-value: p=0.025
In a nationwide Spanish cohort, women undergoing surgical mitral valve replacement had higher incidence rates but lower in-hospital mortality and MACCE compared to men.
(1) Background: Mitral regurgitation (MR) is the second most prevalent valvular heart disease in developed countries. Mitral valve (MV) disease is a common cause of heart failure and a leading cause of morbidity and mortality in the U.S.A. and Europe. (2) Methods: We performed a retrospective study using the Spanish National Hospital Discharge Database, 2001–2015. We included patients that had surgical mitral valve replacement (SMVR) listed as a procedure in their discharge report. We sought to (i) examine trends in incidence of SMVR among women and men in Spain, (ii) compare in-hospital outcomes for mechanical and bioprosthetic SMVR by sex, and (iii) identify factors associated with in-hospital mortality (IHM) after SMVR. (3) Results: We identified 44,340 hospitalizations for SMVR (84% mechanical, 16% bioprosthetic). The incidence of SMVR was higher in women (IRR 1.51; 95% CI 1.48–1.54). The use of mechanical SMVR decreased over time in both sexes and the use of bioprosthetic valves increased over time in both sexes. Men who underwent mechanical and bioprosthetic SMVR had higher comorbidity than women. IHM was significantly lower in women who underwent SMVR than in men (10% vs. 12% p < 0.001 for mechanical and 14% vs. 16% p = 0.025 for bioprosthetic valve, respectively). Major adverse cardiovascular and cerebrovascular events (MACCE) were also significantly lower in women who underwent mechanical and bioprosthetic SMVR. A significant reduction in both in-hospital MACCEs and IHM was observed over the study period regardless of sex. After multivariable logistic regression, male sex was associated with increased IHM only in bioprosthetic SMVR (OR 1.28; 95% CI 1.1–1.5). (4) Conclusions: This nationwide analysis over 15 years of sex-specific outcomes after SMVR showed that incidences are significantly higher in women than men for mechanical and bioprosthetic SMVR. IHM and MACCE have improved over time for SMVR in both sexes. Male sex was independently associated with higher mortality after bioprosthetic SMVR.
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Muñoz‐Rivas et al. (2020) conducted a cohort in Surgical mitral valve replacement (SMVR) (n=44,340). Male sex vs. Female sex was evaluated on In-hospital mortality (bioprosthetic SMVR) (OR 1.28, 95% CI 1.1-1.5, p=0.025). Male sex was independently associated with higher in-hospital mortality compared to female sex after bioprosthetic surgical mitral valve replacement (OR 1.28).
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