Park Soo Jin, Kim Kitae, Kim Hong Rae, Kim Ho Jin, Yoo Jae Suk, Jung Sung-Ho, Chung Cheol Hyun, Kim Joon Bum
Department of Thoracic and Cardiovascular Surgery, Ajou University School of Medicine, Suwon, Korea.
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Seoul, Korea.
Eur J Cardiothorac Surg. 2025 Jun 3;67(6). doi: 10.1093/ejcts/ezaf172.
This study aimed to assess the long-term outcomes of mitral valve (MV) disease depending on sex and its differences within the MV aetiology in patients undergoing MV surgery.
We reviewed 3012 patients undergoing isolated MV surgery with or without tricuspid valve (TV) surgery/ablation between January 2000 and December 2022. The primary end-points were all-cause mortality and a composite valve-related adverse events including heart failure, stroke, reoperation and infective endocarditis. Multivariate analysis with interaction terms identified independent risk factors, with median follow-up of 8.3 years (total 30 180.6 patient-years).
Among the 3012 patients (54.8 ± 12.7 years), 1671 were females (55.5%). Rheumatic and degenerative MV diseases comprised 54.1% and 45.9%, respectively, with higher rates of rheumatic disease in females (69.7% vs 34.7%). Compared to males, females were older with higher prevalence of atrial fibrillation, TV insufficiency and advanced heart failure symptoms, consequently undergoing more MV replacements and concomitant procedures. Females showed higher rates of composite adverse outcomes (hazard ratio [HR], 1.25; 95% confidence intervals [CIs], 1.07-1.46; P = 0.006). Significant interaction was observed between sex and aetiology, with females showing higher mortality (HR 1.51; 95% CIs, 1.12-2.04; P = 0.007) and composite outcomes (HR 1.48; 95% CIs 1.15-1.91; P = 0.002) in degenerative disease (P for interaction = 0.021 and 0.016, respectively). Multivariate Cox regression demonstrated female sex as an independent risk factor for composite valve-related adverse outcomes (adjusted HR, 1.46; 95% CIs, 1.04-2.04; P = 0.028).
Significant sex-based differences exist in MV disease patient characteristics and surgical outcomes, with females experiencing worse results, particularly in degenerative disease. Female sex was an independent risk factor for composite valve-related adverse outcomes after MV surgery. These differences suggest the need for sex-specific diagnostic criteria to reduce the disparities in patients with MV disease.
本研究旨在评估二尖瓣（MV）疾病患者的长期预后，根据性别及其在接受MV手术患者的MV病因中的差异进行分析。
我们回顾了2000年1月至2022年12月期间3012例接受单纯MV手术，伴或不伴有三尖瓣（TV）手术/消融的患者。主要终点是全因死亡率和包括心力衰竭、中风、再次手术和感染性心内膜炎在内的复合瓣膜相关不良事件。通过带有交互项的多变量分析确定独立危险因素，中位随访时间为8.3年（总计30180.6患者年）。
在3012例患者（54.8±12.7岁）中，1671例为女性（55.5%）。风湿性和退行性MV疾病分别占54.1%和45.9%，女性风湿性疾病的发生率更高（69.7%对34.7%）。与男性相比，女性年龄更大，房颤、TV功能不全和晚期心力衰竭症状的患病率更高，因此接受更多的MV置换和同期手术。女性复合不良结局的发生率更高（风险比[HR]，1.25；95%置信区间[CI]，1.07 - 1.46；P = 0.006）。在性别和病因之间观察到显著的交互作用，在退行性疾病中，女性的死亡率（HR 1.51；95% CI，1.12 - 2.04；P = 0.007）和复合结局（HR 1.48；95% CI 1.15 - 1.91；P = 0.002）更高（交互作用的P值分别为0.021和0.016）。多变量Cox回归显示女性性别是复合瓣膜相关不良结局的独立危险因素（调整后HR，1.46；95% CI，1.04 - 2.04；P = 0.028）。
MV疾病患者的特征和手术结局存在显著的性别差异，女性的结果更差，尤其是在退行性疾病中。女性性别是MV手术后复合瓣膜相关不良结局的独立危险因素。这些差异表明需要针对性别的诊断标准以减少MV疾病患者的差异。
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