Gender differences in mitral valve surgery

Thorac Cardiovasc Surg. 2013 Jan;61(1):42-6. doi: 10.1055/s-0032-1331583. Epub 2012 Dec 20.


Background: Knowledge regarding gender-specific mitral valve (MV) pathology and postoperative outcome is rare. We herein describe a single-center experience focusing on gender differences in MV surgery.

Materials and methods: A total of 3,761 patients underwent minimal invasive MV surgery at our institution between 1999 and 2011. Demographic data, pre-, intra-, and postoperative characteristics have been collected, including details on MV pathology and surgical technique. Patient data have been analyzed with consideration of gender-specific differences.

Results: The cohort consisted of 2,124 male (56.5%; 58.8 ± 12.5 years) and 1,637 female (43.5%; 64.5 ± 13 years) patients. Mitral regurgitation was observed equally in women (91.3%) and men (92.4%). Additional MV stenosis has been diagnosed in 2.7% of men but in 13.9% of women (p < 0.001). Calcification of the posterior MV leaflet showed a similar trend: 20.1% in women compared with 6.5% in men. Prolapse of the posterior leaflet was present predominantly in men with 63.1 versus 35.7% in women (p < 0.001). Distinct MV repair differences were retrospectively detected between genders: posterior mitral leaflet resection was performed in 17.9% of men versus 10.1% of women; posterior mitral leaflet chordae replacement was performed in 39.3% of men compared with 20.4% of women. Prosthetic MV replacement was necessary in 26.8% of women compared with only 10.7% of men. Concomitant tricuspid valve surgery was mostly performed in women (14.4 versus 8.2%). Male patients showed a significant better postoperative long-term survival than females, with 96, 89, and 72% compared with 92, 82, and 58% after 1, 5, and 10 years, respectively (p < 0.0001).

Conclusion: Substantial gender-specific differences regarding MV pathology, operative strategy, and long-term outcome are present that need to be addressed in clinical practice.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Calcinosis / surgery
  • Cardiac Surgical Procedures* / adverse effects
  • Female
  • Health Status Disparities*
  • Healthcare Disparities*
  • Heart Valve Diseases / surgery*
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Mitral Valve / surgery*
  • Mitral Valve Insufficiency / surgery
  • Mitral Valve Prolapse / surgery
  • Mitral Valve Stenosis / surgery
  • Postoperative Complications / etiology
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Sex Factors
  • Time Factors
  • Treatment Outcome