Article Impact Level: HIGH Data Quality: STRONG Summary of Journal of the American College of Cardiology, 83(2), 303–312. https://doi.org/10.1016/j.jacc.2023.10.033 Dr. Bryan Q. Abadie et al.
Points
- The study evaluates long-term mortality after mitral valve repair in women compared to men based on preoperative left ventricular systolic dimensions and ejection fraction (EF).
- Retrospective analysis of 4,589 patients undergoing isolated mitral valve repair for degenerative MR reveals that 40% were women, with a median follow-up of 7.2 years and 7.5% mortality.
- Women exhibit an increased risk for all-cause mortality at lower LVESD and LVESDi, as well as higher EF, compared to men.
- The risk for mortality in women increases at LVESD of 3.6 cm, while an inflection point for increased risk with LVESD is not evident in men.
- Findings support the consideration of sex-specific thresholds for LVESDi in surgical decision-making for patients with severe MR, emphasizing the need for tailored approaches to mitigate long-term risks in women.
Summary
The study aimed to evaluate the long-term mortality outcomes following mitral valve repair in women compared to men based on preoperative left ventricular systolic dimensions and ejection fraction (EF). The researchers conducted a retrospective analysis of consecutive patients who underwent isolated mitral valve repair for degenerative mitral regurgitation (MR) at a single institution between 1994 and 2016. Among the 4,589 patients included in the study, 40% were women, and the median follow-up period was 7.2 years, during which 7.5% of the patients had died.
The findings revealed that the risk for all-cause mortality in women increased at lower left ventricular end-systolic dimension (LVESD) and LVESD indexed to body surface area (LVESDi), as well as at higher EF, compared to men. Specifically, the risk for mortality in women increased from the baseline hazard at an LVESD of 3.6 cm, while an inflection point for increased risk with LVESD was not evident in men. Similarly, for LVESDi, the risk for women increased at 1.8 cm/m2 compared with 2.1 cm/m2 in men. Furthermore, although women and men had a similar inflection point for EF (58%), mortality was higher for women as EF decreased.
In conclusion, the study highlights the higher risk of all-cause mortality in women following mitral valve repair at lower LVESD and LVESDi and higher EF compared to men. These results underscore the importance of considering sex-specific thresholds for LVESDi in the surgical decision-making process for patients with severe MR, emphasizing the need for tailored approaches to mitigate the long-term risks associated with mitral valve repair in women.
Link to the article: https://onlinelibrary.wiley.com/doi/10.1002/clc.24123
References Abadie, B. Q., Cremer, P. C., Vakamudi, S., Gillinov, A. M., Svensson, L. G., & Cho, L. (2024). Sex-Specific Prognosis of Left Ventricular Size and Function Following Repair of Degenerative Mitral Regurgitation. Journal of the American College of Cardiology, 83(2), 303–312. https://doi.org/10.1016/j.jacc.2023.10.033
