背景:退行性二尖瓣反流与心力衰竭有关,心律失常,和死亡率。性别对手术转诊时机和结果的影响尚未全面报道。我们检查了接受手术的男性与女性DMR患者的术前状态和手术结果。
方法:我们回顾了我们在2013年至2021年期间接受退行性二尖瓣反流手术的所有患者的机构数据库。术前临床和超声心动图变量,手术特点,和结果进行了比较;以及现有图像中的左心房应变。
结果:在963名患者中,314(32.6%)为女性。妇女年龄较大(67vs.64年,p=0.031),更常见的是双叶脱垂(19.4%vs.13.8%,p=0.028),二尖瓣环钙化(12.1%vs.5.4%,p<0.001)和三尖瓣返流(TR;31.8%vs.22.5%,p=0.001)。女性左心室舒张末期和收缩末期直径指数较高,与29.4vs.26.7mm/m2(p<0.001)和18.2vs.17mm/m2(p<0.001),分别,左心房导管应变较低(17.6%vs,21.2%,p=0.001)。预测的死亡风险为0.73%,而不是男性为0.54%(p=0.023)。女性需要更频繁的机械循环支持(1.3%vs0%,p=0.011),重症监护病房住院时间更长(29vs.26小时,p<0.001),机械通气(5.4vs.5小时,p=0.036),和总体住院(7vs.6天,p<0.001)。长期无再次手术生存率无差异(p=0.35)。
结论:接受二尖瓣修复的女性年龄较大,显示出长期左心室损害的晚期疾病的指标。准则可能需要调整并解决这一差距,以改善术后恢复时间和结果。
BACKGROUND: Degenerative mitral regurgitation is associated with heart failure, arrhythmia, and mortality. The impact of sex on timing of surgical referral and outcomes has not been reported comprehensively. We examined preoperative status and surgical outcomes of male versus female DMR patients undergoing surgery.
METHODS: We reviewed our institutional database for all patients undergoing surgery for degenerative mitral regurgitation between 2013 and 2021. Preoperative clinical and echocardiographic variables, surgical characteristics, and outcomes were compared; and left atrial strain in available images.
RESULTS: Of 963 patients, 314 (32.6%) were female. Women were older (67 vs. 64 years, p = 0.031) and more often had bileaflet prolapse (19.4% vs. 13.8%, p = 0.028), mitral annular calcification (12.1% vs. 5.4%, p < 0.001) and tricuspid regurgitation (TR; 31.8% vs. 22.5%, p = 0.001). Indexed left ventricular end-diastolic and end-systolic diameters were higher in women, with 29.4 vs. 26.7 mm/m2 (p < 0.001) and 18.2 vs. 17 mm/m2 (p < 0.001), respectively, and left atrial conduit strain lower (17.6% vs, 21.2%, p = 0.001). Predicted risk of mortality was 0.73% vs. 0.54% in men (p = 0.023). Women required mechanical circulatory support more frequently (1.3% vs 0%, p = 0.011), had longer intensive care unit stay (29 vs. 26 hours, p < 0.001), mechanical ventilation (5.4 vs. 5 hours, p = 0.036), and overall hospitalization (7 vs. 6 days, p < 0.001). There was no difference in long-term re-operation-free survival (p = 0.35).
CONCLUSIONS: Women undergoing mitral valve repair are older and show indicators of more advanced disease with long-standing left ventricular impairment. Guidelines may need to be adjusted and address this disparity, to improve postoperative recovery times and outcomes.