title: Determinants of late outcomes in women undergoing mitral repair of myxomatous degeneration.
abstract: Studies have consistently shown that women have worse perioperative outcomes following mitral surgery compared with men. Few data are available that explain these divergent outcomes. This study was conducted to determine whether women with degenerative mitral valve disease present to surgery with more advanced disease than men, and to determine whether these differences influence long-term clinical outcomes.
  
  
  
  Seven hundred and forty-three patients underwent repair of mitral regurgitation due to myxomatous degeneration between 2001 and 2014. Of these, 208 (28%) were females and concomitant coronary bypass grafting was performed in 103 (14%). The mean clinical follow-up was for 3.1 years, and extended to 11.9 years.
  
  
  
  Perioperative mortality was 0.1%. Preoperatively, women had a larger indexed left atrial diameter (27.9 ± 5.7 vs 25.3 ± 4.7 mm/m2, P = 0.0001), larger indexed left ventricle end-systolic dimension (20.6 ± 5.5 vs 18.7 ± 5.1 mm/m2, P = 0.028) and higher right ventricular systolic pressure (44.4 ± 14.4 vs 41.7 ± 13.3 mmHg, P = 0.026) compared with men. Five-year survival and freedom from recurrent MR ≥2+ were 88.7 ± 1.8 and 90.7 ± 1.6%, respectively. Although gender was not associated with survival (hazard ratio: 1.04 ± 0.4, P = 0.91), women were more likely to develop recurrent MR ≥2+ at follow-up compared with men (hazard ratio: 1.9 ± 0.5, P = 0.007).
  
  
  
  In this large series, women with degenerative mitral valve disease presented with echocardiographic markers suggestive of more advanced disease at the time of surgery. Although there was no difference in early or late survival between groups, women were more likely to develop recurrent MR ≥2+ over the course of follow-up. Earlier surgical referral of women may, therefore, be advised.
authors.affiliation: Division of Cardiac Surgery, University of Ottawa, Ottawa, ON, Canada vchan@ottawaheart.ca.|School of Epidemiology, Public Health, and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada.
authors.forename: Vincent
authors.initials: V
authors.lastname: Chan
authors.affiliation: School of Epidemiology, Public Health, and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada.
authors.forename: Li
authors.initials: L
authors.lastname: Chen
authors.affiliation: Division of Cardiac Surgery, University of Ottawa, Ottawa, ON, Canada.
authors.forename: Elsayed
authors.initials: E
authors.lastname: Elmistekawy
authors.affiliation: Division of Cardiac Surgery, University of Ottawa, Ottawa, ON, Canada.|School of Epidemiology, Public Health, and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada.
authors.forename: Marc
authors.initials: M
authors.lastname: Ruel
authors.affiliation: Division of Cardiac Surgery, University of Ottawa, Ottawa, ON, Canada.
authors.forename: Thierry G
authors.initials: TG
authors.lastname: Mesana
mesh_terms: D000368:Aged; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D058386:Mitral Valve Annuloplasty / Q000401:mortality*; D008945:Mitral Valve Prolapse / Q000175:diagnosis / Q000601:surgery*; D009864:Ontario / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome
keywords: Echocardiography; Female; Mitral valve repair