Impact of Sex on Cardiac Remodelling and Long-Term Outcomes Following
Mitral Valve Replacement
Abstract
Background: Differences in cardiac remodeling after mitral valve (MV)
surgery between the sexes is poorly understood. Inferior outcomes for
females undergoing MV surgery compared to males have been suggested in
the literature, although causative factors behind this discrepancy have
not been identified. Materials and Methods: In this propensity-matched,
retrospective, single-center study, we sought to identify the impact
that sex may have on cardiac remodeling and long-term outcomes to better
inform clinical decision making in MV surgical intervention. Outcomes
were compared between males and females undergoing MV replacement (MVR)
between 2004 and 2018. The primary outcome was cardiac remodeling 1 year
postoperatively. Secondary outcomes included mortality, stroke,
myocardial infarction (MI), reoperation of the MV, and
rehospitalization. Results: 314 males and 314 females were included
after propensity matching. Males demonstrated a significant degree of
improved left ventricular remodeling while females did not, and females
showed a significant degree of left atrial remodeling while males did
not. Mortality rates were relatively equivalent between the two groups,
although males were more likely to develop sepsis and require
rehospitalization due to MI. Conclusions: There has been little research
exploring the differences in cardiac remodeling between the sexes after
MVR. The results of this study have suggested that MVR is equally safe
for both sexes and has demonstrated a difference in the heart’s ability
to remodel after MVR. The significance of this difference has the
potential to result in largely different clinical outcomes for males and
females. Further study is necessary to fully elucidate this
relationship.