Abstract 12090: Impact of Gender in Surgical Presentation and Long-Term Outcome of Organic Mitral Regurgitation
Background: Recommendations for management of organic mitral regurgitation (OMR) are not sex-specific because the impact of gender on presentation upon outcome remains largely unknown.
Aims: To determine the preoperative clinical presentation of OMR and the long-term outcomes after mitral valve surgery in women compared to men.
Methods: We analyzed 655 patients (201 women, 31%) who underwent mitral surgery for pure, acquired, isolated OMR (1990-2000; 92% degenerative OMR) who had preoperative echocardiography performed.
Results: Women vs. men had similar age (65±14 vs. 63±13, p=0.22) and Ejection Fraction (EF: 64±8 vs. 63±9%, p=0.15). OMR was quantified less often as severe in women (72 vs. 82%, p=0.01), yet women more frequently presented with severe symptoms (NYHA class III-IV; 37 vs. 19%, p=0.01) despite a higher use of ACE-inhibitor/ARBs (59 vs. 48%, p=0.009) and Beta-Blocker (22 vs. 15%, p=0.02) therapy. The prevalence of left ventricular (LV) class I (EF≤60% or LV end systolic diameter ≥40mm; 32 vs. 37%) or class IIa (atrial fibrillation or pulmonary hypertension 16 vs. 13%) triggers for surgery were similar between genders yet. Thus, women underwent early mitral surgery (without triggers) less frequently than men (28 vs. 39%, p=0.007). Surgically, women had a lower rate of mitral valve repair (86 vs. 93%; p=0.03) and less concomitant bypass grafting (17 vs. 26%, p=0.02).
During follow-up of 9.8±4.1 years, there were 207 deaths and 104 patients were hospitalized for heart failure. Women had the same survival as men (33 vs. 31% at 15 years; p=0.6) but more frequently had heart failure (21 vs. 14% at 15 years; p=0.02). After adjustment for EF, age, comorbidity, atrial fibrillation, type of procedure (repair vs. replacement), and concomitant bypass grafting, women had higher risk for heart failure then men (HR 1.63[1.06-2.48], p≤0.03).
Conclusion: Women underwent mitral surgery for OMR with a more advanced clinical presentation but less frequently had valve repair than men. During long-term follow-up, women had similar survival to men but excess heart failure risk. Efforts to improve the detection and treatment of mitral valve regurgitation in women appear warranted.
- © 2013 by American Heart Association, Inc.