Impact of sex on outcomes after percutaneous repair of functional mitral
valve regurgitation
Abstract
Background The role of percutaneous repair of functional mitral
regurgitation (MR) is evolving. Left ventricle remodeling is known to be
different between men and women; however, outcomes following
percutaneous repair of functional MR have not considered the impact of
sex. Methods Between 2012 and 2018, 175 patients underwent percutaneous
repair of functional MR with the Mitra Clip NT/NTR (Abbott, Irvine CA)
at our institution. Patients were assessed in a dedicated clinic with a
follow-up that averaged 0.7±1.2 years and extended to 5.7 years. Results
Men had a larger body surface area than women (p<0.001),
whereas women were more likely than men to have diabetes preoperatively
(p=0.02). There were no deaths or instances of single leaflet
detachment. Immediate post-procedure MR was <2+ in 158 (90%)
with a mean trans-mitral valve repair gradient of 3.4±1.0 and 3.5±2.1 mm
Hg, respectively for women and men (p=0.8). One- and 2-year freedom from
MR >3+ was 86.0±3.5% and 77.6±5.1%, respectively. After
adjusting for differences between male and female patients, women were
more likely to have recurrent MR >3+ (hazard ratio 4.7,
95% confidence interval 1.2-18.4, p=0.03). Upon adjusted analysis,
there was also no association between gender and survival (p=0.2). One-
and 2- year survival was 69.8±4.3% and 54.3±5.5%, respectively.
Conclusion Women are more likely to have recurrent severe MR after
percutaneous repair of functional MR. The mechanism for this remains
undetermined.