Work

Sex-based differences in outcomes of mitral valve surgery: A meta-analysis of propensity score-matched studies with reconstructed time-to-event data

Year: 2025

Type: review

Study designs: Systematic Review, Meta-Analysis

Abstract: Background: Studies indicate worse outcomes for women undergoing mitral valve surgery, but this can be biased in the context of differences in risk profiles between sexes. We aimed to assess short- and long-term outcomes of mitral valve surgery in men and women using confounder-adjusted data. Methods: We searched PubMed, Embase, and the Cochrane Library for eligible propensity-score-matched studies. Analysis was performed for short-term (<30 days mortality and procedural complications) and long-term (>1 year mortality, reoperation, and mitral regurgitation) endpoints. A pairwise random-effects meta-analysis was done for short-term outcomes, pooling risk ratios (RR) with 95 % confidence intervals (CIs). A meta-analysis of Kaplan-Meier derived individual patient data was conducted for long-term endpoints. Cox frailty regression analysis was used to obtain hazard ratios (HR). Results: We included 12 studies (n = 55,616). No significant differences were observed in the short-term risks of death (RR 1.02; 95 % CI: 0.91-1.15; p = 0.72), stroke (RR 1.04; 95 % CI: 0.87-1.26; p = 0.65), kidney injury (RR 0.97; 95 % CI: 0.71-1.32; p = 0.85), atrial fibrillation (RR 0.96; 95 % CI: 0.81-1.14; p = 0.61), or pacemaker implantation (RR 0.93; 95 % CI: 0.84-1.02; p = 0.1). The hazards of long-term mortality (HR 0.97; 95 % CI: 0.91-1.03; p = 0.3) and reoperation (HR 1.65; 95 % CI: 0.39-6.91; p = 0.5) were similar between sexes. However, women had a higher hazard of recurrent mitral regurgitation (HR 1.61; 95 % CI: 1.08-2.37; p = 0.018). Conclusions: This meta-analysis found no sex-based differences in short- or long-term mortality, reoperation rates, or procedural complications following mitral valve surgery. A higher hazard of recurrent mitral regurgitation was observed in women.

Source: American Heart Journal Plus Cardiology Research and Practice

DOI: 10.1016/j.ahjo.2025.100682