Malik Mohsyn Imran, Nedadur Rashmi, Fox Stephanie, Hage Ali, Hage Fadi, Tzemos Nikolaos, Chu Michael W A
Division of Cardiac Surgery, Department of Surgery, Western University, London, Ontario, Canada.
Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada.
Ann Thorac Surg. 2025 Jun;119(6):1278-1285. doi: 10.1016/j.athoracsur.2024.08.010. Epub 2024 Aug 30.
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.
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.
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.
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.
性别差异在大多数心血管疾病中仍然普遍存在，并且女性在疾病早期和晚期的预后仍然明显更差，尤其是在手术修复后。本研究旨在按性别调查二尖瓣（MV）修复的预后，并确定改进的机会。
对2008年5月至2023年2月期间连续接受MV修复的患者进行单中心回顾性分析。按性别检查住院和长期预后，包括生存率和症状性疾病复发情况。使用逆概率治疗加权法进行调整后的预后分析。
共有490例患者接受了MV修复（中位年龄65岁；四分位间距[IQR]为57 - 73岁；胸骨切开术n = 128[26%]，微创n = 362[74%]），其中男性343例，女性147例。中位随访时间为5.4年（IQR，3.1 - 8.4年）。女性与男性经逆概率治疗加权调整后的30天预后，包括死亡（1.4%对0.6%，P = 0.59）和主要不良心血管事件（8.2%对7.6%，P = 0.81），无显著差异。二尖瓣修复后女性与男性的2年生存率分别为94.9%和98.0%，4年生存率分别为91.4%和97.8%，8年生存率分别为87.2%和88.7%（风险比，0.52；IQR，0.19 - 1.44）。未调整和经逆概率治疗加权调整的生存及无症状性疾病复发的Cox回归风险比在长期随访中显示两性之间无显著差异。
这些当代研究结果令人鼓舞，表明通过包括早期检测和认知以及改进手术技术在内的综合努力，可以实现两性之间关键的“差距弥合”，不过其他因素可能需要进一步探索。
