Conclusions
In this study, we looked to identify the impact of sex on remodeling and
outcomes post MVR. After propensity matching and isolating for surgical
approach, our results demonstrate significant cardiac remodeling
postoperatively for both sexes. Interestingly the cardiac remodeling was
inconsistent between the two groups. Males showed significantly improved
remodeling of the LV while females had significant remodeling of the LA.
A study by Goldstein et al randomized 251 patients to either MV repair
or replacement and followed the patients for 2 years. Both MV repair and
replacement groups demonstrated significant remodeling of the LV
end-systolic volume index within the first year postoperatively
[22]. Ebd Alaziz & Ibrahim similarly followed 20 males and 25
females who had undergone MVR for chronic MR. These patients
demonstrated a reduction in LVEF from 61.09±7.6% to 59.67±6.56%, in LA
size from 5.55±0.88cm to 4±0.54cm, and LV end-systolic diameter from
4.06±0.65cm to 3.45±0.51cm at 1-year postoperatively [23]. Even so,
no studies have compared the differences in remodeling between sexes
with a large number of propensity-matched patients and our results
demonstrate a difference in the heart’s ability to remodel after MVR.
Males demonstrated a significant reduction in LV size and LVEF, while
females did not. Females demonstrated a significant reduction in LA size
and volume, while males did not. This distinction in cardiac remodeling
demonstrates variability in cardiac adaptation after MV surgery. The
significance of this difference has the potential to result in variable
clinical outcomes for males and females, including long-term freedom
from heart failure and mortality. Further study is necessary to fully
elucidate this relationship.
In contrast to previous literature, our results demonstrated that after
propensity matching and isolating for surgical approach females and
males have similar rates of morbidity and mortality post MVR, and when
there were significant differences between the sexes males had inferior
outcomes. Vassileva et al performed a study including 47,602 patients
undergoing isolated MV surgery and divided patients by sex and surgical
approach [12]. This study found the MV repair rate for males was
44.0% and 31.9% for females, with remaining patients receiving MVR.
Higher operative and in-hospital mortality rates were identified for
females. Women demonstrated a higher mortality rate than men with 8.2%
and 9.3% for males and females respectively. Even after adjustment for
differences in baseline characteristics and admission status, the
mortality rate for females undergoing MVR was still increased compared
to their male counterparts [12]. Song et al demonstrated similar
results with their study of 24,977 patients from The STS National
Database who underwent isolated MV repair or replacement [18].
Females were shown to have significantly increased rates of morbidity
and mortality with the largest difference being in the 40-59 year age
group with approximately 2.5x the rates of mortality in females as
compared to males, this survival disadvantage diminished with aging
[18]. As there were multiple potential causes of these discrepancies
in prior literature, we sought to identify whether sex alone impacts the
outcomes post-MV surgery by matching patients based on comorbidities and
isolating for surgical approach. We found no significant difference in
mortality between males and females following MVR. Our results
demonstrated that when males and females were matched for preoperative
comorbidities and surgical approaches, males had inferior postoperative
with an increased likelihood of developing sepsis and requiring
rehospitalization due to MI postoperatively than females.
Our results have demonstrated significant variations in cardiac
remodeling between males and females post MVR. Both males and females
demonstrated significant changes in MVA as well as peak and mean
gradients, although chamber remodeling was distinctly different between
the sexes. Males demonstrated a significant reduction in LV diameter and
LVEF while females did not show these changes. In contrast, females
showed a significant reduction in LA diameter and volume while males did
not. This difference in chamber remodeling demonstrates variability in
the heart’s ability to adapt after MV surgery. The significance of this
difference is unknown but has the potential to result in different
clinical outcomes between the sexes, including long-term freedom from
symptoms of heart failure and rates of mortality. Further study of this
discrepancy is necessary to fully elucidate this relationship.