Department of Surgery, Division of Cardiac Surgery, Feinberg School of Medicine, Bluhm Cardiovascular Institute, Northwestern University, Chicago, IL, USA.
Department of Medicine, Division of Cardiology, Feinberg School of Medicine, Bluhm Cardiovascular Institute, Northwestern University, Chicago, IL, USA.
Interact Cardiovasc Thorac Surg. 2021 Aug 18;33(3):325-332. doi: 10.1093/icvts/ivab090.
This study was conducted to determine if gender bias explains the worse outcomes in women than in men who undergo mitral valve surgery for degenerative mitral regurgitation.
Patients who underwent mitral valve surgery for degenerative mitral regurgitation with or without concomitant ablation surgery for atrial fibrillation were identified from the Cardiovascular Research Database of the Clinical Trial Unit of the Bluhm Cardiovascular Institute at Northwestern Memorial Hospital and were defined according to the Society of Thoracic Surgery National Adult Cardiac Surgery Database. Of the 1004 patients (33% female, mean age 62.1 ± 12.4 years; 67% male, mean age 60.1 ± 12.4 years) who met this criteria, propensity score matching was utilized to compare sex-related differences.
Propensity score matching of 540 patients (270 females, mean age 61.0 ± 12.2; 270 males, mean age 60.9 ± 12.3) demonstrated that 98% of mitral valve surgery performed in both groups was mitral valve repair and 2% was mitral valve replacement. Preoperative CHA2DS2-VASc scores were higher in women and fewer women were discharged directly to their homes. Before surgery, women had smaller left heart chambers, lower cardiac outputs, higher diastolic filling pressures and higher volume responsiveness than men. However, preoperative left ventricular and right ventricular strain values, which are normally higher in women, were similar in the 2 groups, indicating worse global strain in women prior to surgery.
The worse outcomes reported in women compared to men undergoing surgery for degenerative mitral regurgitation are misleading and not based on gender bias except in terms of referral patterns. Men and women who present with the same type and degree of mitral valve disease and similar comorbidities receive the same types of surgical procedures and experience similar postoperative outcomes. Speckle-tracking echocardiography to assess global longitudinal strain of the left and right ventricles should be utilized to monitor for myocardial dysfunction related to chronic mitral regurgitation.
本研究旨在确定在因退行性二尖瓣反流而行二尖瓣手术的患者中，性别偏见是否导致女性的预后较男性更差。
从西北纪念医院胸外科临床研究数据库心血管研究数据库中确定了因退行性二尖瓣反流而行二尖瓣手术且伴有或不伴有房颤消融手术的患者，并根据胸外科医师学会国家成人心脏手术数据库进行了定义。在符合该标准的 1004 例患者中（33%为女性，平均年龄 62.1±12.4 岁；67%为男性，平均年龄 60.1±12.4 岁），利用倾向评分匹配比较了性别相关差异。
对 540 例患者（270 例女性，平均年龄 61.0±12.2 岁；270 例男性，平均年龄 60.9±12.3 岁）进行倾向评分匹配后发现，两组患者 98%行二尖瓣修复术，2%行二尖瓣置换术。女性术前 CHA2DS2-VASc 评分较高，且直接出院回家的女性比例较低。手术前，女性左心腔较小，心输出量较低，舒张充盈压较高，容量反应性较高。然而，术前左心室和右心室应变值在女性中通常较高，但在两组之间相似，表明手术前女性的整体应变较差。
与因退行性二尖瓣反流而行手术的男性相比，女性的预后较差，这是有误导性的，不能归因于性别偏见，除非是转诊模式。患有相同类型和程度的二尖瓣疾病以及相似合并症的男性和女性接受相同类型的手术，并且经历相似的术后结局。应利用斑点追踪超声心动图评估左、右心室的整体纵向应变，以监测与慢性二尖瓣反流相关的心肌功能障碍。
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