Impact of gender on postoperative outcome after posterior chordal preservation during isolated mitral valve replacement: A retrospective propensity score matched study

Yasser Kamal; Ahmed Orieby

Yasser Kamal ‎Department of Cardiothoracic Surgery, Faculty of Medicine, Minia University, El-‎Minya, Egypt
Ahmed Orieby ‎Department of Cardiothoracic Surgery, Faculty of Medicine, Minia University, El-‎Minya, Egypt

Keywords: Mitral valve replacement, chordal preservation, gender differences, rheumatic valve disease

Abstract

Background: Female patients experience poorer clinical results after mitral valve surgery. Preserving the sub-valvular chordae may lead to lower morbidity and mortality after mitral valve replacement (MVR) for both genders. This study aimed to compare operative mortality and postoperative morbidity following preservation of posterior mitral leaflet during isolated mechanical MVR, between male and female patients.

Methods: This retrospective study involved adult patients of either gender who had primary isolated MVR. The primary end-point of outcome was a combination of negative postoperative results, including operative mortality and complications. The outcomes were compared based on gender before and after adjusting for preoperative factors related to gender using 1:1 propensity score matching.

Results: The initial sample consisted of 380 patients, mostly female (215/380; 56.57%) with an average age of 51.45±10.79 years. Female patients showed higher rates of previous congestive heart failure, NYHA class III/IV, low ejection fraction, pulmonary hypertension, and atrial fibrillation. After surgery, female patients experienced a significant increase in hospital stay (9.30±3.55 vs 8.95±3.27 days, P = 0.02), total postoperative complications (7% vs 2.4%, P = 0.04), and adverse outcome rates (7.9% vs 2.4%, P = 0.02), with no significant difference in hospital mortality (1.4% vs 0.6%, P = 0.63). In the matched group of 330 patients, there were no significant differences in postoperative results (P < 0.05). Female gender associated with significantly higher odds for the composite of adverse outcomes (OR: 3.45, 95%CI: 1.14 -10.47, P = 0.02), which was not seen in the matched group (OR: 2.05, 95%CI: 0.60-6.94, P = 0.24).

Conclusion: Female gender did not influence the rate of operative mortality after posterior chordal preservation during MVR, but female patients experienced higher rate of overall postoperative complications and longer duration of hospital stay than male patients. When adjusting for preoperative risk factors, female gender did not impact postoperative outcomes.