Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Ascension Texas Cardiovascular and the University of Texas at Austin Dell Medical School, Austin, Texas, USA.
J Am Coll Cardiol. 2024 Jan 16;83(2):303-312. doi: 10.1016/j.jacc.2023.10.033.
Prior studies have demonstrated worse long-term outcomes for women after surgery for severe mitral regurgitation (MR). The current Class I indications for surgery for severe degenerative MR use cutoffs of left ventricular end-systolic dimension (LVESD) and left ventricular ejection fraction (EF) that do not account for known sex-related differences.
The primary objective of this study was to assess long-term mortality following mitral valve repair in women compared with men on the basis of preoperative left ventricular systolic dimensions and EF.
Consecutive patients who underwent isolated mitral valve repair for degenerative MR at a single institution between 1994 and 2016 were screened. Adjusted HRs for all-cause mortality were compared according to baseline LVESD, LVESD indexed to body surface area (LVESDi), and EF for men and women.
Among 4,589 patients, 1,825 were women (40%), and after a median follow-up period of 7.2 years, 344 patients (7.5%) had died. The risk for mortality for women increased from the baseline hazard at an LVESD of 3.6 cm, whereas an inflection point for increased risk with LVESD was not evident in men. Regarding LVESDi, the risk for women increased at 1.8 cm/m compared with 2.1 cm/m in men. For EF, women and men had a similar inflection point (58%); however, mortality was higher for women as EF decreased.
After mitral valve repair, women have a higher risk for all-cause mortality at lower LVESD and LVESDi and higher EF. These results support consideration of sex-specific thresholds for LVESDi in surgical decision making for patients with severe MR.
先前的研究表明，女性在接受重度二尖瓣反流（MR）手术后的长期预后较差。目前，对于严重退行性 MR 的手术，I 类适应证使用左心室收缩末期直径（LVESD）和左心室射血分数（EF）的截断值，这些截断值并未考虑到已知的性别差异。
本研究的主要目的是根据术前左心室收缩末期尺寸和 EF，评估女性与男性在接受二尖瓣瓣修复手术后的长期死亡率。
筛选了 1994 年至 2016 年期间在一家机构接受孤立性二尖瓣修复治疗退行性 MR 的连续患者。根据 LVESD、LVESD 索引到体表面积（LVESDi）和 EF，比较男性和女性的全因死亡率的调整 HR。
在 4589 例患者中，有 1825 例女性（40%），中位随访时间为 7.2 年后，有 344 例患者（7.5%）死亡。女性的死亡率从 LVESD 为 3.6cm 的基础风险开始增加，而男性的 LVESD 不存在风险增加的拐点。关于 LVESDi，女性的风险增加发生在 1.8cm/m，而男性的风险增加发生在 2.1cm/m。对于 EF，女性和男性的拐点相似（58%）；然而，随着 EF 的降低，女性的死亡率更高。
在二尖瓣瓣修复术后，女性在较低的 LVESD 和 LVESDi 以及较高的 EF 时，全因死亡率的风险更高。这些结果支持在严重 MR 患者的手术决策中考虑基于性别的 LVESDi 阈值。
