Difference in outcome among women and men after percutaneous mitral valvuloplasty.
OBJECTIVE
To analyze the differences in anatomical, clinical and echocardiographic characteristics of women and men undergoing PMV and to evaluate the relationship between sex, PMV success, and immediate and long-term clinical outcome.


BACKGROUND
Rheumatic mitral stenosis (MS) is predominantly a disease of middle-aged women. Percutaneous mitral valvuloplasty (PMV) has become the standard of care for suitable patients. However little is known about the relationship between sex, PMV success, and procedural outcome.


RESULTS
We evaluated measures of procedural success and clinical outcome in consecutive patients (839 women and 176 men) who underwent PMV. Despite a lower baseline echocardiographic score (7.47 ± 2.15 vs. 8.02 ± 2.18, P = 0.002), women were less likely to achieve PMV success (69% vs. 83%, adjusted OR 0.44, 95% CI 0.27-0.74, P = 0.002), and had a smaller post-procedural MV area (1.86 ± 0.7 vs. 2.07 ± 0.7 cm(2), P < 0.001). Overall procedural and in-hospital complication rates did not differ significantly between women and men. However, women were significantly more likely to develop severe MR immediately post PMV (adjusted OR 2.41, 95% CI 1.0-5.83, P = 0.05) and to undergo MV surgery (adjusted HR 1.54, 95% CI 1.03-2.3, P = 0.037) after a median follow-up of 3.1 years.


CONCLUSIONS
Compared to men, women with rheumatic MS who undergo PMV are less likely to have a successful outcome and more likely to require MV surgery on long-term follow-up despite more favorable baseline MV anatomy.
Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA. cruzgonzalez.ignacio@gmail.com
Ignacio
I
Cruz-Gonzalez
Hani
H
Jneid
Maria
M
Sanchez-Ledesma
Roberto J
RJ
Cubeddu
Javier
J
Martin-Moreiras
Pablo
P
Rengifo-Moreno
Tullio A
TA
Diaz
Thomas J
TJ
Kiernan
Ignacio
I
Inglessis-Azuaje
Andrew O
AO
Maree
Pedro L
PL
Sanchez
Igor F
IF
Palacios
D000328:Adult; D000368:Aged; D002404:Catheterization / Q000009:adverse effects; D016009:Chi-Square Distribution; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D008946:Mitral Valve Stenosis / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D016017:Odds Ratio; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013030:Spain; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography