Cheng Yu-Hua, Ma Wei-Guo, Zeng Jian-Wen, Han Yun-Fei, Sun Kai, Huang Wei-Qin
Department of Anesthesiology, Wuhan Asia Heart Hospital, Wuhan, People's Republic of China.
Division of Cardiac Surgery, Yale School of Medicine, New Haven, Connecticut, United States.
Thorac Cardiovasc Surg. 2024 Sep 9. doi: 10.1055/a-2382-8206.
This study aimed to compare the gender differences in isolated mitral regurgitation (MR) repair.
Of 381 adults aged 54.8 ± 12.3 years undergoing mitral valve repair (MVP) for isolated MR from January 2019 to December 2022, the baseline and operative data, and outcomes were compared between 161 women (42.3%) and 220 men (57.7%).
Women tended to be nonsmokers (98.1 vs. 45%, 0.001), and have more cerebrovascular accidents (38.5% vs. 24.1%, = 0.004) and isolated annular dilatation (19.3 vs. 9.1%, = 0.010), lower creatinine (70.0 ± 19.5 vs. 86.3 ± 19.9 μmol/dL, 0.001), and smaller left ventricular end-diastolic diameter (LVEDD; 54.4 ± 6.7 vs. 57.8 ± 6.6 mm, 0.001). One female died of stroke at 2 days (0.3%). Another female (0.3%) underwent mitral valve replacement for failed repair. Stroke occurred in 4 (1.0%). Two underwent reexploration for bleeding (0.5%). Women were more likely to have less 24-hour drainage (290 ± 143 vs. 385 ± 196 mL, 0.001). Over a mean follow-up of 2.1 ± 1.1 years (100% complete), 1 woman died and 1 man underwent a reoperation; 28 had moderate MR, and 9 had severe MR. Neither did early and late mortality and reoperation, nor freedom from late moderate or severe MR (71.6 vs. 71.4% at 5 years; = 0.992) differ significantly between the two genders. Predictors for late moderate or severe MR were anterior leaflet prolapse (hazard ratio [HR] 4.45; 95% confidence interval [CI] 1.18-16.72; = 0.027) and isolated annular dilation (HR 5.47, 95% CI 1.29-23.25; = 0.021).
In this series of patients undergoing isolated MR repair, despite significant differences in smoking, cerebrovascular accidents, creatinine, LVEDD, and isolated annular dilatation at baseline, and 24-hour drainage postoperatively, women and men did not show significant differences in early and late survival, reoperation, and freedom from late moderate or severe MR.
本研究旨在比较孤立性二尖瓣反流（MR）修复中的性别差异。
在2019年1月至2022年12月期间接受孤立性MR二尖瓣修复术（MVP）的381例年龄为54.8±12.3岁的成年人中，对161名女性（42.3%）和220名男性（57.7%）的基线、手术数据及结果进行比较。
女性更倾向于不吸烟（98.1%对45%，P = 0.001），有更多的脑血管意外（38.5%对24.1%，P = 0.004）和孤立性瓣环扩张（19.3%对9.1%，P = 0.010），肌酐水平较低（70.0±19.5对86.3±19.9μmol/dL，P = 0.001），左心室舒张末期内径（LVEDD）较小（54.4±6.7对57.8±6.6mm，P = 0.001）。1名女性在术后2天死于中风（0.3%）。另1名女性（0.3%）因修复失败接受二尖瓣置换术。4例（1.0%）发生中风。2例因出血接受再次手术（0.5%）。女性术后24小时引流量往往更少（290±143对385±196mL，P = 0.001）。在平均2.1±1.1年的随访期（100%完整）内，1名女性死亡，1名男性接受再次手术；28例有中度MR，9例有重度MR。两性在早期和晚期死亡率、再次手术率以及无晚期中度或重度MR方面（5年时分别为71.6%对71.4%；P = 0.992）均无显著差异。晚期中度或重度MR的预测因素为前叶脱垂（风险比[HR] 4.45；95%置信区间[CI] 1.18 - 16.72；P = 0.027）和孤立性瓣环扩张（HR 5.47，95% CI 1.29 - 23.25；P = 0.021）。
在这组接受孤立性MR修复的患者中，尽管在基线时吸烟、脑血管意外、肌酐、LVEDD和孤立性瓣环扩张以及术后24小时引流量方面存在显著差异，但男女在早期和晚期生存率、再次手术率以及无晚期中度或重度MR方面并无显著差异。
