Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
Cardiology. 2022;147(3):337-347. doi: 10.1159/000524378. Epub 2022 Apr 20.
Inequalities in postoperative outcomes between males and females are well described with females often experiencing inferior outcomes after heart valve surgery. The 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.
PubMed, MEDLINE, and Scopus were systematically searched for all studies comparing outcomes between males and females undergoing TMVr and TMVR. A total of 2,178 English manuscript titles and abstracts were reviewed. Articles were excluded if data were not provided regarding sex differences, transcatheter MV intervention, full-length text was not accessible, or if insufficient data was provided. A total of 2,170 articles were excluded, and 8 articles were included in this study.
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.
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.
男性和女性术后结局的不平等现象已有充分描述，女性在心脏瓣膜手术后常经历较差的结局。最近的文献表明，女性经导管主动脉瓣置换术后的结局相当或改善。经导管二尖瓣修复术（TMVr）和置换术（TMVR）是一个相对较新的领域，比较男女之间性别差异的文献明显较少。本系统评价和荟萃分析旨在全面总结比较经导管 MV 介入治疗的男性和女性结局的已发表文献。
系统检索 PubMed、MEDLINE 和 Scopus，以获取所有比较 TMVr 和 TMVR 男性和女性结局的研究。共审查了 2178 篇英文手稿标题和摘要。如果未提供关于性别差异、经导管 MV 干预、无法获取全文或提供的数据不足的信息，则排除这些文章。共排除 2170 篇文章，纳入 8 篇文章进行研究。
汇总的结局指标显示，急性肾损伤的发生率（OR 1.28[95%CI，1.14-1.44;p<0.0001]）有利于女性，而大出血的发生率则有利于男性（OR 0.85[95%CI，0.76-0.96;p=0.01]）。死亡率、术后心肌梗死和卒中等结局无显著差异。
在心脏瓣膜干预中出现了一种趋势，即男性经外科干预后结局改善，而女性经经导管干预后结局相当或改善。本荟萃分析确定男性急性肾损伤发生率较高，女性大出血发生率较高，而接受 TMVr 的男性和女性的发病率和死亡率相当。
