S.Chiu Wong1,3, Ilhwan Yeo2, Geoffrey Bergman1, Robert Minutello1, Dmitriy Feldman1, Richard Devereux1, Luke Kim11Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
2Division of Hospital Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
3Electronic correspondence: firstname.lastname@example.org
Background and aim of the study: The study aim was to delineate the influence of gender on procedural outcomes and on temporal trends for in-hospital clinical outcomes after isolated mitral valve surgery.
Methods: Patients aged ≥65 years who underwent isolated mitral valve surgery were identified from the 2003-2014 National Inpatient Sample files. Comparisons were made of the prevalence of in-hospital major adverse cardiac and cerebral events (MACCE: all-cause mortality, stroke, or myocardial infarction [MI]), permanent pacemaker implantation, bleeding requiring transfusion, acute kidney injury requiring hemodialysis and prolonged hospital stay, in women and men. Temporal trends of in-hospital MACCE and all-cause mortality, stratified by repair and replacement, were also compared between genders.
Results: A total of 69,067 isolated mitral valve surgeries was identified (59.7% replacements, 40.3% repairs). Women had higher rates of MACCE, all-cause mortality, stroke, and MI than men after surgery. In multivariate
regression analyses, female gender was independently associated with higher MACCE (OR = 1.29, 95% CI = 1.13-1.47, p = 0.0002) driven by higher in-hospital mortality (OR = 1.26, 95% CI = 1.08-1.47, p = 0.003), MI (OR = 1.53, 95% CI = 1.16-2.02, p = 0.003) and bleeding requiring transfusion (OR = 1.14, 95% CI = 1.02-1.27, p = 0.02). In analyses by type of mitral valve surgery, patients undergoing repair fared better than those with replacements. Female gender was associated with increased in-hospital MACCE, all-cause mortality and MI after replacement, and with bleeding requiring transfusion after repair. Over the study period, significant improvement in MACCE was demonstrated in both genders, particularly in males.
Conclusion: Despite improvements in temporal trends of in-hospital clinical outcomes after mitral valve operations, a significant gender gap remains. Awareness of gender differences in diagnosis, medical management and surgical planning may help mitigate these differences.
The Journal of Heart Valve Disease 2018-19;27:221-235
|Impact of Gender on In-Hospital Clinical Outcomes Following Isolated Mitral Valve Surgery|
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