Sex-Based Differences in Outcomes After Mitral Valve Surgery for Severe Ischemic Mitral Regurgitation: From the Cardiothoracic Surgical Trials Network

JACC Heart Fail. 2019 Jun;7(6):481-490. doi: 10.1016/j.jchf.2019.03.001.


Objectives: This study investigated sex-based differences in outcomes after mitral valve (MV) surgery for severe ischemic mitral regurgitation (SIMR).

Background: Whether differences in outcomes exist between men and women after surgery for SIMR remains unknown.

Methods: Patients enrolled in a randomized trial comparing MV replacement versus MV repair for SIMR were included and followed for 2 years. Endpoints for this analysis included all-cause mortality, major adverse cardiovascular and cerebrovascular events (MACCE) (defined as the composite of death, stroke, hospitalization for heart failure, worsening New York Heart Association functional class or MV re-operation), quality of life (QOL), functional status, and percentage of change in left ventricular end-systolic volume index (LVESVI) from baseline through 2 years.

Results: Of 251 patients enrolled in the trial, 96 (38.2%) were women. Compared with men, women had smaller LV volumes and effective regurgitant orifice areas (EROA) but greater EROA/left ventricular (LV) end-diastolic volume ratios. At 2 years, women had higher rates of all-cause mortality (27.1% vs. 17.4%, respectively; adjusted hazard ratio [adjHR]: 1.85; 95% confidence interval [CI]: 1.05 to 3.26; p = 0.03) and of MACCE (49.0% vs. 38.1%, respectively; adjHR: 1.58; 95% CI: 1.06 to 2.37; p = 0.02). Women also reported worse QOL and functional status at 2 years. There were no significant differences in the percentage of change over 2 years in LVESVI between women and men (adjβ: -10.4; 95% CI: -23.4 to 2.6; p = 0.12).

Conclusions: Women with SIMR displayed different echocardiographic features and experienced higher mortality and worse QOL after MV surgery than men. There were no significant differences in the degree of reverse LV remodeling between sexes. (Comparing the Effectiveness of Repairing Versus Replacing the Heart's Mitral Valve in People With Severe Chronic Ischemic Mitral Regurgitation [Severe Ischemic Mitral Regurgitation]; NCT00807040).

Keywords: ischemic mitral regurgitation; mitral valve repair; mitral valve replacement; women.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Cause of Death
  • Disease Progression
  • Female
  • Heart Failure
  • Heart Valve Prosthesis Implantation*
  • Hospitalization / statistics & numerical data
  • Humans
  • Male
  • Middle Aged
  • Mitral Valve Annuloplasty*
  • Mitral Valve Insufficiency / etiology
  • Mitral Valve Insufficiency / surgery*
  • Mortality
  • Myocardial Infarction / complications*
  • Myocardial Infarction / physiopathology
  • Myocardial Ischemia / complications
  • Myocardial Ischemia / physiopathology
  • Quality of Life
  • Reoperation
  • Severity of Illness Index
  • Sex Factors
  • Stroke / epidemiology
  • Stroke Volume / physiology
  • Treatment Outcome
  • Ventricular Remodeling / physiology

Associated data