背景:二尖瓣返流(mr)是老年人中最常见的瓣膜性心脏病(vhd),并且在女性中更普遍。虽然相关的性别差异在手术治疗的集体中很明显,越来越多的接受经导管边缘到边缘修复(teer)的患者队列中,性别特异性数据非常有限且相互矛盾.
目的:调查性别是否影响手术安全性和有效性,以及住院和长期结果,在为先生准备之后。
方法:在一项多中心观察队列研究中,根据性别和相关结局指标对进行了试验的患者进行了分层,并使用多变量cox回归和倾向得分匹配(psm)进行分析。
结果:共分析了821例患者,其中37.4%(307/821)为女性。与男性患者相比,女性年龄明显较大(77±8.5vs.80.4±6.7年,p=0.03),冠状动脉疾病较少(cad,67.7%与53.1%,p<0.0001)和较高比例的保留左心室功能(lvef>50%,32.5%vs.50.5%,p>0.0001)。Teer手术的安全性和有效性以及院内死亡率在性别之间没有差异.在psm之后,与男性相比,女性在试验后3年的生存率显著提高(60.7%vs.54.2%,p=0.04),根据多重cox回归分析,全因死亡的风险较低(hr0.8,95%ci0.6-0.9,p=0.02)。在对伴随房颤(af)进行性别特异性分层后,当前集体中最常见的合并症,与没有af的女性相比,af的女性调整后生存率明显更差(53.9%vs.75.1%,p=0.042)三年后,与男性相比失去了生存优势。
结论:女性患者比接受TEER的男性患者年龄大,合并症少。TEER程序在两性中同样安全有效。虽然住院死亡率没有差异,女性患者的调整后长期生存率明显优于男性患者.伴随房颤抵消了女性对男性的预后优势,与男性相比,严重损害接受TEER的女性的长期生存。有必要进行进一步的研究,以阐明观察到的性别差异的根本原因,并制定针对性别的治疗建议。
BACKGROUND: mitral regurgitation (mr) is the most common valvular heart disease (vhd) in the elderly and tends to be more prevalent in women. while relevant sex differences in outcomes are evident in surgically treated collectives, there are very limited and conflicting sex-specific data for the growing cohort of patients undergoing transcatheter edge-to-edge repair (teer).
OBJECTIVE: to investigate whether sex impacts procedural safety and efficacy, and in-hospital- and long-term outcomes, after teer for mr.
METHODS: in a multicenter observational cohort study, patients who underwent teer were stratified by sex and relevant outcome measures, and analyzed using multivariable cox regression and propensity score matching (psm).
RESULTS: a total of 821 patients were analyzed, of whom 37.4% (307/821) were female. compared to male patients, females were significantly older (77 ± 8.5 vs. 80.4 ± 6.7 years, p = 0.03), and had less coronary artery disease (cad, 67.7% vs. 53.1%, p < 0.0001) and a higher proportion of preserved left ventricular function (lvef > 50%, 32.5% vs. 50.5%, p > 0.0001). safety and efficacy of the teer procedure and in-hospital mortality did not differ between the sexes. after psm, women showed significantly better survival 3 years after teer compared to men (60.7% vs. 54.2%, p = 0.04) and a lower risk of all-cause death according to multiple cox regression (hr 0.8, 95% ci 0.6-0.9, p = 0.02). after sex-specific stratification for concomitant atrial fibrillation (af), the most common comorbidity in the present collective, women with af experience significantly worse adjusted survival compared to women without af (53.9% vs. 75.1%, p = 0.042) three years after teer and lose the survival advantage over men.
CONCLUSIONS: female patients are older and less comorbid than males undergoing TEER. The TEER procedure is equally safe and effective in both sexes. While in-hospital mortality did not differ, female patients experienced a significantly better adjusted long-term survival compared to male patients. Concomitant AF offsets the prognostic advantage of females over males and, in contrast to males, significantly impairs long-term survival in women undergoing TEER. Further research is warranted to elucidate underlying causes for the observed sex disparities and to develop sex-tailored treatment recommendations.