Long Edouard, Chehab Omar, Rajah Tanisha, Dunn Roberta, Androshchuk Vitaliy, Wilcox Joshua, Gill Harminder, Avlonitis Vassilios, Bosco Paolo, Lucchese Gianluca, Patterson Tiffany, Redwood Simon, Rajani Ronak
Institute of Cardiovascular Science, University College London, London W1W 7TS, UK.
Faculty of Life Sciences and Medicine, King's College London, London SE1 9NH, UK.
J Clin Med. 2025 Apr 28;14(9):3054. doi: 10.3390/jcm14093054.
: Sex-related differences in the presentation and outcomes of patients with mitral regurgitation (MR) undergoing mitral valve (MV) surgery remain unclear. We aimed to identify these differences to inform personalized management. A total of 143 consecutive patients undergoing surgery for MR between 2017 and 2018 were stratified by sex and assessed for differences in characteristics. We performed 1:1 propensity score matching (PSM) by sex, with baseline characteristics as covariates, yielding 38 comparable pairs which were analyzed for differences in all-cause mortality and post-operative length of stay (LOS). Females ( = 67) were more symptomatic (NYHA Class ≥ 3: 73% vs. 45%, < 0.001), had higher logistic EuroSCORE (5.5 vs. 3.9, = 0.006), had more urgent operations (25% vs. 11%, = 0.020), MV replacements (28% vs. 11%, = 0.007), and secondary MR (43% vs. 16%, < 0.001). Females had significantly smaller end-diastolic and end-systolic left ventricular (LV) diameters, though indexed diameters showed no significant differences. After PSM, females had significantly longer LOS (7 days vs. 9 days, = 0.033) and no differences in long-term mortality (hazard ratio [HR]: 1.25, 95% confidence interval [CI]: 0.34-4.76, = 0.7, median follow-up: 6.67 years). An indexed LV end-systolic diameter (LVESDi) > 19 mm/m yielded greater specificity (46.0% vs. 26.7%) and comparable sensitivity (69.4% vs. 69.2%) to LVESD > 40 mm. In subgroup analyses, female patients undergoing concomitant tricuspid intervention (HR: 6.80 [1.63-37.92], < 0.01) or urgent operation (HR: 4.85 [1.08-21.06], = 0.04) had worse prognoses than males. Females undergoing MV surgery for MR had more symptoms, higher surgical risk, and longer LOS, but similar mortality compared to males. However, concomitant tricuspid intervention and urgent operations were associated with higher mortality. Our results add to the growing body of evidence that current non-indexed LV diameter thresholds may not adequately account for sex differences.
二尖瓣反流（MR）患者接受二尖瓣（MV）手术时的表现及预后的性别差异尚不清楚。我们旨在确定这些差异，为个性化管理提供依据。2017年至2018年间，共有143例连续接受MR手术的患者按性别分层，并评估其特征差异。我们按性别进行1:1倾向评分匹配（PSM），将基线特征作为协变量，得到38对可比组，分析全因死亡率和术后住院时间（LOS）的差异。女性（n = 67）症状更明显（纽约心脏协会[NYHA]分级≥3级：73%对45%，P < 0.001），逻辑欧洲心脏手术风险评估系统（EuroSCORE）更高（5.5对3.9，P = 0.006），急诊手术更多（25%对11%，P = 0.020），MV置换术更多（28%对11%，P = 0.007），继发性MR更多（43%对16%，P < 0.001）。女性舒张末期和收缩末期左心室（LV）直径明显更小，尽管指数化直径无显著差异。PSM后，女性LOS明显更长（7天对9天，P = 0.033），长期死亡率无差异（风险比[HR]：1.25，95%置信区间[CI]：0.34 - 4.76，P = 0.7，中位随访时间：6.67年）。左心室收缩末期指数直径（LVESDi）> 19 mm/m2对LVESD > 40 mm具有更高的特异性（46.0%对26.7%）和相当的敏感性（69.4%对69.2%）。在亚组分析中，接受同期三尖瓣干预（HR：6.80[1.63 - 37.92]，P < 0.01）或急诊手术（HR：4.85[1.08 - 21.06]，P = 0.04）的女性患者预后比男性更差。接受MR的MV手术的女性症状更多、手术风险更高、LOS更长，但与男性的死亡率相似。然而，同期三尖瓣干预和急诊手术与更高的死亡率相关。我们的结果进一步证明，目前未指数化的LV直径阈值可能无法充分考虑性别差异。
