Author + information
- Received December 4, 2018
- Revision received February 17, 2019
- Accepted March 5, 2019
- Published online May 27, 2019.
- Gennaro Giustino, MDa,b,
- Jessica Overbey, MSb,
- Doris Taylor, PhDc,
- Gorav Ailawadi, MDd,
- Katherine Kirkwood, MSb,
- Joseph DeRose, MDe,
- Marc A. Gillinov, MDf,
- François Dagenais, MDg,
- Mary-Lou Mayer, RNh,
- Alan Moskowitz, MDb,
- Emilia Bagiella, PhDb,
- Marissa Miller, DVM, MPHi,
- Paul Grayburn, MDj,
- Peter K. Smith, MDk,
- Annetine Gelijns, PhDb,∗ (, )
- Patrick O'Gara, MDl,
- Michael Acker, MDh,
- Anuradha Lala, MDa,b,∗ and
- Judy Hung, MDm,∗
- aThe Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
- bDepartment of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
- cDepartment of Regenerative Medicine Research, Texas Heart Institute, Houston, Texas
- dDivision of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia
- eDepartment of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
- fDepartment of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
- gInstitut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
- hDepartment of Surgery, Division of Cardiovascular Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
- iNational Heart, Lung, and Blood Institute of the National Institutes of Health, Bethesda, Maryland
- jDivision of Cardiology, Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas
- kDivision of Cardiothoracic Surgery, Department of Surgery, Duke University, Durham, North Carolina
- lDivision of Cardiology, Brigham and Women’s’ Hospital, Boston, Massachusetts
- mDivision of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
- ↵∗Address for correspondence:
Dr. Annetine C. Gelijns, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1077, New York, New York 10029.
Objectives This study investigated sex-based differences in outcomes after mitral valve (MV) surgery for severe ischemic mitral regurgitation (SIMR).
Background Whether differences in outcomes exist between men and women after surgery for SIMR remains unknown.
Methods Patients enrolled in a randomized trial comparing MV replacement versus MV repair for SIMR were included and followed for 2 years. Endpoints for this analysis included all-cause mortality, major adverse cardiovascular and cerebrovascular events (MACCE) (defined as the composite of death, stroke, hospitalization for heart failure, worsening New York Heart Association functional class or MV re-operation), quality of life (QOL), functional status, and percentage of change in left ventricular end-systolic volume index (LVESVI) from baseline through 2 years.
Results Of 251 patients enrolled in the trial, 96 (38.2%) were women. Compared with men, women had smaller LV volumes and effective regurgitant orifice areas (EROA) but greater EROA/left ventricular (LV) end-diastolic volume ratios. At 2 years, women had higher rates of all-cause mortality (27.1% vs. 17.4%, respectively; adjusted hazard ratio [adjHR]: 1.85; 95% confidence interval [CI]: 1.05 to 3.26; p = 0.03) and of MACCE (49.0% vs. 38.1%, respectively; adjHR: 1.58; 95% CI: 1.06 to 2.37; p = 0.02). Women also reported worse QOL and functional status at 2 years. There were no significant differences in the percentage of change over 2 years in LVESVI between women and men (adjβ: −10.4; 95% CI: −23.4 to 2.6; p = 0.12).
Conclusions Women with SIMR displayed different echocardiographic features and experienced higher mortality and worse QOL after MV surgery than men. There were no significant differences in the degree of reverse LV remodeling between sexes. (Comparing the Effectiveness of Repairing Versus Replacing the Heart's Mitral Valve in People With Severe Chronic Ischemic Mitral Regurgitation [Severe Ischemic Mitral Regurgitation]; NCT00807040)
↵∗ Drs. Lala and Hung contributed equally to this work and are joint senior authors.
The Severe Ischemic Mitral Regurgitation trial was supported by a cooperative agreement among National Institutes of Health National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Neurological Disorders and Stroke (NINDS), and Canadian Institutes of Health Research (grant U01 HL088942). The views expressed in this article are those of the authors and do not necessarily represent the views of the NHLBI, the NIH, or the U.S. Department of Health and Human Services. Dr. Ailawadi is a member of the advisory board for Abbott. Dr. Gillinov is a consultant for Abbott, Medtronic, Edwards Lifesciences, CryoLife, and Atricure. Dr. Grayburn has received grant support from Abbott Vascular, Boston Scientific, Edwards Lifesciences, Medtronic, and Neochord; has served as a consultant for Abbott Vascular, Edwards Lifesciences, Medtronic, and Neochord; and has received core laboratory support from Edwards Lifesciences and Neochord. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received December 4, 2018.
- Revision received February 17, 2019.
- Accepted March 5, 2019.
- 2019 American College of Cardiology Foundation
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