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Tsuyoshi Kaneko, MD: Gender Differences in Mitral Valve Re-Operation

A cardiac surgeon from Brigham and Women's Hospital discusses a recent study he led assessing gender disparities in outcomes following re-operation in patients who have undergone mitral valve repair.

Despite multiple studies indicating women were more likely to experience a negative outcome following mitral valve repair, a recent study from a team of physicians at Brigham and Women’s Hospital has found female sex was not a significant predictor of negative outcomes following re-operation.

Instead of revealing that female sex alone was a significant predictor of re-operation following mitral valve repair, the results of the study indicated the apparent re-operation risk observed in the study was mostly attributable to worse preoperative profiles.

To further assess factors potentially contributing to disparities in outcomes following mitral valve surgery, investigators performed a review of all adult patients who underwent mitral valve repair at Brigham and Women’s Hospital between January 2002-June 2016. In total, 2463 patients were identified for inclusion, including 947 women.

The primary outcome of interest in the study was any intervention for repair failure or MV disease progression over the follow-up period, which lasted a median of 8.2 years. Secondary outcomes of the study included operative mortality, in-hospital re-operation for bleeding or redo valve, incidence of permanent stroke, and new-onset renal failure.

Of note, women included in the analysis were older, had higher STS-risk scores, and were more likely to have rheumatic disease than their male counterparts.

Upon analysis, women had higher operative mortality (2.7% vs 1.7%; P=.09) and a significantly higher 10-year re-operation risk than their male counterparts (7% vs 4%). In adjusted analyses, rheumatic disease in women was associated with increased 10-year re-operation risk (HR, 4.04; P=.001), but female sex alone was not found to be a significant predictor of risk (P=.21).

For more on the results of this study and potential future research into the topic, Practical Cardiology™ invited lead investigator Tsuyoshi Kaneko, MD, a cardiothoracic surgeon at Brigham and Women’s Hospital to take part in an interview to discuss data from his study.

This study, “Sex-based differences in mitral valve Re-operation after mitral valve repair: Truth or myth?,” was published in The American Journal of Surgery.