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Impact of Sex on Cardiac Remodelling and Long-Term Outcomes Following Mitral Valve Replacement
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  • Ryaan EL-Andari,
  • Sabin Bozso,
  • Jimmy Kang,
  • Dana Boe,
  • Nicholas Fialka,
  • Yongzhe Hong,
  • Michael Moon,
  • Darren Freed,
  • Jayan Nagendran,
  • Jeevan Nagendran
Ryaan EL-Andari
University of Alberta
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Sabin Bozso
University of Alberta
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Jimmy Kang
University of Alberta
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Dana Boe
University of Alberta
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Nicholas Fialka
University of Alberta
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Yongzhe Hong
University of Alberta
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Michael Moon
University of Alberta
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Darren Freed
University of Alberta
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Jayan Nagendran
University of Alberta
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Jeevan Nagendran
University of Alberta
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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.

Peer review status:ACCEPTED

02 Oct 2020Submitted to Journal of Cardiac Surgery
05 Oct 2020Submission Checks Completed
05 Oct 2020Assigned to Editor
07 Oct 2020Reviewer(s) Assigned
16 Oct 2020Review(s) Completed, Editorial Evaluation Pending
17 Oct 2020Editorial Decision: Revise Major
31 Oct 20201st Revision Received
05 Nov 2020Submission Checks Completed
05 Nov 2020Assigned to Editor
05 Nov 2020Reviewer(s) Assigned
11 Nov 2020Review(s) Completed, Editorial Evaluation Pending
14 Nov 2020Editorial Decision: Revise Minor
28 Nov 20202nd Revision Received
01 Dec 2020Submission Checks Completed
01 Dec 2020Assigned to Editor
02 Dec 2020Reviewer(s) Assigned
02 Dec 2020Review(s) Completed, Editorial Evaluation Pending
02 Dec 2020Editorial Decision: Revise Minor
04 Dec 20203rd Revision Received
04 Dec 2020Assigned to Editor
04 Dec 2020Submission Checks Completed
05 Dec 2020Reviewer(s) Assigned
05 Dec 2020Review(s) Completed, Editorial Evaluation Pending
06 Dec 2020Editorial Decision: Accept