Mitral Valve Repair for Primary Mitral Regurgitation: Long-Term Outcomes in Women vs Men

Female patients undergoing mitral valve surgery have worse short- and long-term survival compared with male patients. Less is known about long-term outcomes other than survival.

All patients who underwent mitral valve repair for primary mitral regurgitation from 2003 to 2012 at a single high-volume center were investigated. The aim of this retrospective, observational study was to investigate long-term survival, cumulative incidence of reoperation and recurrent mitral regurgitation, as well as sex differences in perioperative characteristics and at follow-up.

A total of 848 patients were included, of whom 28.4% (n = 241) were female. The mean age was 61.8 ± 13.6 years for women and 56.9 ± 11.4 years for men (P < .001). Median follow-up was 13.0 (interquartile range, 8.8-15.5) years. Women were more often affected by anterior leaflet prolapse (P = .018) and calcification of the mitral valve (P = .022) than men. In unadjusted analysis, survival differed significantly for women and men: 10-year survival was 77.3% and 85.8%; 20-year survival was 57.6% and 59.5%, respectively (P = .010). However, female sex was not identified as risk factor for death (hazard ratio [HR], 0.989, P = .947), but age (HR, 1.101; P < .001), atrial fibrillation (HR, 2.109, P = .007), and reduced left ventricular ejection fraction <55% (HR, 2.937, P < .001) were. Cumulative incidence of reoperation at 10 and 20 years after mitral valve repair was 12.5% and 20.7% for women, and 11.5% and 22.3% for men (P = .859).

Long-term survival was significantly worse for women, which can be attributed to higher age at baseline. Reoperation rates were comparable for all patients, although female patients presented with more complex mitral valve pathology.