Sex Differences and Mitral Valve Surgery

Sex Differences in Mitral Regurgitation Before and After Mitral Valve Surgery

Author: Grayburn, P.A.

There are important differences between men and women referred for surgery for primary MR in an experienced mitral valve center of excellence. The authors report a retrospective analysis of 217 women and 447 men who underwent surgery at Mayo Clinic between 1990 and 2000 with comprehensive echocardiographic imaging, including MR quantitation performed pre-operatively (27 ± 35 days) and post-operatively (6 ± 10 months). Age and other demographic characteristics were very similar between the sexes, but women had smaller body surface area (BSA) and were more likely to have heart failure (HF) symptoms (41% vs. 19%, respectively; p < 0.0001) and be prescribed HF therapy. LV diastolic and systolic diameters, left atrial (LA) diameter, LV mass, regurgitant volume (RVol), and effective regurgitant orifice area (EROA) were all significantly smaller in women, and fewer women were classified with severe MR, presumably due to lower RVol and EROA. After they were indexed for BSA, women had slightly higher LV and LA diameters than men, with no differences in RVol, suggesting that the LV volume overload was similar between men and women when BSA was taken into account. This hypothesis is further supported by strikingly similar reductions in men and women in LV and LA diameters post-operatively. Reduction in PA systolic pressure post-operatively was slightly greater in women, despite starting with higher PA pressures.

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