Overcoming the Disparity in Mitral Valve Repair: A Sex-Based Analysis of Long-Term Outcomes.

BACKGROUND

Sex disparities remain pervasive across most cardiovascular diseases and continue to demonstrate notably worse early and late outcomes for women, especially after surgical repair. This study aims to investigate outcomes of mitral valve (MV) repair by sex and identify opportunities for improvement.

METHODS

A single center retrospective analysis of consecutive patients undergoing MV repair from May 2008 to February 2023 was conducted. In-hospital and long-term outcomes, including survival and symptomatic disease recurrence were examined by sex. Adjusted outcome analysis was performed using inverse-probability treatment weighting.

RESULTS

In total, 490 patients underwent MV repair (median age, 65 years; interquartile range [IQR], 57-73 years; sternotomy n = 128 [26%], minimally invasive n = 362 [74%]), including 343 male and 147 female patients. Median follow-up time was 5.4 years (IQR, 3.1-8.4 years). inverse-probability treatment weighting-adjusted 30-day outcomes for female vs male, including death (1.4% vs 0.6%, P = .59) and major adverse cardiovascular events (8.2% vs 7.6%, P = .81), were not significantly different. Survival for female vs male after mitral valve repair was 94.9% vs 98.0% at 2 years, 91.4% vs 97.8% at 4 years, and 87.2% vs 88.7% at 8 years (hazard ratio, 0.52; IQR, 0.19-1.44). Both unadjusted and inverse-probability treatment weighting-adjusted Cox-regression hazard ratios for survival and freedom from symptomatic disease recurrence demonstrated no significant difference between sexes at long-term follow-up.

CONCLUSIONS

These contemporary results are encouraging and suggest that a critical "bridging of the gap" between sexes is possible with comprehensive efforts including earlier detection and awareness and improved surgical techniques, though other factors may be important to explore further.