부산대학교 도서관

Introduction: Studies have shown that mitral valve repair (MVr) for severe mitral regurgitation (MR) restores normal life expectancy in men, but not in women. The reasons for this difference in long term mortality are unknown. The purpose of this study was to evaluate men and women who underwent isolated mitral valve repair and compare differences in mortality for the current AHA/ACC class I indications for surgery: symptoms, ejection fraction (EF) ≤ 60%, and left ventricular internal dimension at end-systole (LVIDs) ≥ 4.0 cm.Methods: All patients who underwent isolated mitral valve repair for the primary indication of degenerative MR at a single institution between 1994 and 2016 were screened. Patients were excluded if they underwent a concomitant surgical intervention or did not have 1 year of follow up data.Results: A total of 12,880 patients underwent surgery for severe degenerative MR of which 5,267 had an isolated MVr and 1 year of follow up data. There was 3,159 men and 2,108 women in the study. Men and women had similar age and pre-operative ejection fraction, with some difference in pre-operative comorbidities (see Figure). EF was a predictor of death in both women and men, although the hazard ratio was higher in women [HR 1. 78 (CI 1.30 - 2.40, p = 0.017) vs 1.37 (CI 1.06 - 1.78, p < 0.001)]. In men, symptoms (HR 0.98 CI 0.73 - 1.31, p = 0.878) and increased LVIDs (HR 1.12 CI 0.87 - 1.62, 0.277) did not predict mortality. However, in women, the presence of symptoms did predict death (HR 1.80 CI 1.06 - 3.05, p = 0.029). An increased LVIDs trended towards death but did not quite meet statistical significance (HR 1.41 CI 0.99 - 2.00, p = 0.059) in women.Conclusion: The non-gender-specific thresholds for mitral valve surgery in the current guidelines may underestimate disease severity in women as they were associated with an increased risk of death compared to men. Therefore, delaying surgery until women meet these thresholds may be exposing them to undue harm.