title: Gender differences in mitral valve surgery.
abstract: BACKGROUND
  Knowledge regarding gender-specific mitral valve (MV) pathology and postoperative outcome is rare. We herein describe a single-center experience focusing on gender differences in MV surgery.
  
  
  METHODS
  A total of 3,761 patients underwent minimal invasive MV surgery at our institution between 1999 and 2011. Demographic data, pre-, intra-, and postoperative characteristics have been collected, including details on MV pathology and surgical technique. Patient data have been analyzed with consideration of gender-specific differences.
  
  
  RESULTS
  The cohort consisted of 2,124 male (56.5%; 58.8 ± 12.5 years) and 1,637 female (43.5%; 64.5 ± 13 years) patients. Mitral regurgitation was observed equally in women (91.3%) and men (92.4%). Additional MV stenosis has been diagnosed in 2.7% of men but in 13.9% of women (p < 0.001). Calcification of the posterior MV leaflet showed a similar trend: 20.1% in women compared with 6.5% in men. Prolapse of the posterior leaflet was present predominantly in men with 63.1 versus 35.7% in women (p < 0.001). Distinct MV repair differences were retrospectively detected between genders: posterior mitral leaflet resection was performed in 17.9% of men versus 10.1% of women; posterior mitral leaflet chordae replacement was performed in 39.3% of men compared with 20.4% of women. Prosthetic MV replacement was necessary in 26.8% of women compared with only 10.7% of men. Concomitant tricuspid valve surgery was mostly performed in women (14.4 versus 8.2%). Male patients showed a significant better postoperative long-term survival than females, with 96, 89, and 72% compared with 92, 82, and 58% after 1, 5, and 10 years, respectively (p < 0.0001).
  
  
  CONCLUSIONS
  Substantial gender-specific differences regarding MV pathology, operative strategy, and long-term outcome are present that need to be addressed in clinical practice.
authors.affiliation: Department of Cardiac Surgery, Heartcenter Leipzig, Leipzig, Germany. seej@med.uni-leipzig.de
authors.forename: Joerg
authors.initials: J
authors.lastname: Seeburger
authors.forename: Sandra
authors.initials: S
authors.lastname: Eifert
authors.forename: Bettina
authors.initials: B
authors.lastname: Pfannmüller
authors.forename: Jens
authors.initials: J
authors.lastname: Garbade
authors.forename: Marcel
authors.initials: M
authors.lastname: Vollroth
authors.forename: Martin
authors.initials: M
authors.lastname: Misfeld
authors.forename: Michael
authors.initials: M
authors.lastname: Borger
authors.forename: Friedrich Wilhelm
authors.initials: FW
authors.lastname: Mohr
mesh_terms: D000368:Aged; D002114:Calcinosis / Q000601:surgery; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D005260:Female; D054624:Health Status Disparities; D054625:Healthcare Disparities; D006349:Heart Valve Diseases / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000601:surgery; D008945:Mitral Valve Prolapse / Q000601:surgery; D008946:Mitral Valve Stenosis / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome