Sex-Based Differences in Outcomes Following Mitral Valve Surgery: A Contemporary Analysis From 2 Institutions

Despite differences in operative characteristics in patients with mitral valve disease, it remains unclear if sex is an independent risk factor associated with perioperative mortality after mitral valve surgery.

We performed a retrospective cohort study of 3313 adult patients who underwent mitral valve surgery between 2011 and 2024 at 2 academic institutions. Patients were stratified by sex, and the primary outcome was operative mortality. Multivariable logistic regression was used to identify independent predictors of operative mortality.

In our cohort, 44.5% were women. Women were older (63.9 versus 62.2 years, P<0.0001), more likely to have New York Heart Association class III (15.9% versus 7.6%) and IV (1.4 versus 1.1%) heart failure (P<0.05 for both), and less likely to undergo mitral valve repair (63.5% versus 80.0%, P<0.0001). Women had shorter cross-clamp times (101.1 versus 105.0 min, P<0.01). Although postoperative intensive care unit stay was longer for women (3.0 versus 2.3 days, P<0.0001), operative mortality did not differ significantly by sex (1.42% versus 0.92%, P=0.32). In multivariable regression, female sex was not significantly associated with mortality after adjusting for covariates (odds ratio [OR], 1.03 [95% CI, 0.39-2.77], P=0.66). Prolonged cardiopulmonary bypass time was significantly associated with an increased odds of postoperative mortality (OR, 1.01 per 10 minutes [95% CI, 1.01-1.02], P=0.002).

Despite differences in baseline characteristics and surgical approach, operative mortality did not differ significantly by sex. Female sex was not significantly associated with operative mortality after adjustment for clinical and operative factors in patients undergoing elective mitral valve surgery.