Male–female differences in characteristics and early outcomes of patients undergoing tricuspid valve surgery: a national cohort study in the Netherlands

Veen, Kevin M; Mokhles, Mostafa M; Braun, Jerry; Versteegh, Michel I.M.; Bogers, Ad J.J.C.; Takkenberg, Johanna J.M.

doi:10.1093/ejcts/ezy390

Cited by 8 publications

(6 citation statements)

References 20 publications

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“…Previous studies utilizing the NHR data in isolated mitral valve surgery, tricuspid valve surgery and combined aortic valve and CABG surgery have shown differences between male and female patients in risk factors and the weights of risk factors for in-hospital mortality ( 20 - 22 ). This demonstrates the presence of differences and the importance to investigate these differences in an aortic surgery population.…”

Section: Discussionmentioning

confidence: 99%

Male-female differences in contemporary elective ascending aortic surgery: insights from the Netherlands Heart Registration

Gökalp,

Thijssen,

Bekkers

et al. 2023

Ann Cardiothorac Surg

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Background Scientific research regarding male-female differences in ascending aortic surgery is scarce. The objective of this study was to identify male-female differences in presentation, treatment and peri-operative outcome in elective ascending aortic surgery. Methods Elective ascending aortic surgery procedures that took place in the Netherlands between 01/01/2013–31/12/2017 were identified from the Netherlands Heart Registration. Male-female differences in presentation, treatment characteristics, and in-hospital mortality and morbidity were explored. Results The study population consisted of 887 females (31%) and 1,972 males (69%). Females were older (median age 67 versus 62 years, P<0.001), more often had chronic lung disease (12.3% versus 9.1%, P=0.011), New York Heart Association (NYHA) class III−IV (21.5% versus 15.5%, P=0.003), and less often a history of percutaneous coronary intervention (PCI) (3.2% versus 5.0%, P=0.033). Isolated supracoronary aortic replacement was performed in 47.7% of females versus 30.6% of males (P<0.001), and ascending aorta with root replacement in 40.6% of females versus 56.7% of males (P<0.001). Females more often underwent concomitant interventions of the aortic arch (33.1% versus 20.2%, P<0.001) and the mitral valve (8.2% versus 5.2%, P=0.002), and less often concomitant coronary artery bypass grafting (CABG) (14.4% versus 19.1%, P=0.002). Overall, in-hospital mortality was significantly higher in females (5.1% versus 2.7%, P=0.003). In multivariable regression analysis, being female was an independent risk factor for in-hospital mortality [odds ratio (OR) 1.55, 95% confidence interval (CI): 1.02–2.37]. Conclusions This nation-wide cohort shows clear differences between females and males in patient presentation, procedural characteristics, in-hospital outcomes, and risk factors for in-hospital mortality in elective ascending aortic surgery. Further exploration of these differences, and of modifiable within-male and within-female risk factors, may offer great opportunities in improving treatment and thereby outcomes for both males and females.

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Section: Discussionmentioning

confidence: 99%

Male-female differences in contemporary elective ascending aortic surgery: insights from the Netherlands Heart Registration

Gökalp,

Thijssen,

Bekkers

et al. 2023

Ann Cardiothorac Surg

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“…Sex-specific differences in treatment outcomes after open heart surgery: The analysis of TR treatment outcomes revealed that there was no statistically significant difference between males and females in both in-hospital mortality (RR: 1.19; 95% CI (0.86, 1.64); p = 0.29; I² = 45%) and late mortality (RR: 0.99; 95% CI (0.17, 5.65); p = 0.99) among patients who underwent open heart surgery. In one of the studies, it is highlighted that there were no significant differences in hospital mortality between males and females undergoing isolated tricuspid valve surgery, tricuspid valve repair, and replacement [18]. Similar results were present with no difference in in-hospital mortality/30-day mortality between both sexes.…”

Section: Sex-specific Differences In Treatment Outcomesmentioning

confidence: 78%

Unveiling Sex Differences in Tricuspid Valve Disease: A Systematic Review and Meta-Analysis of Surgical Management

Khan,

Surve,

Senthilkumar

et al. 2023

Cureus

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Tricuspid regurgitation (TR) is a heart condition where blood flows backward through the tricuspid valve. Tricuspid valve disease constitutes a major valvular heart condition that is receiving heightened attention due to tailored treatment options and sex-specific differences in treatment outcomes. The study aims to investigate whether biological sex has a significant influence on the development, progression, and treatment outcomes of tricuspid valve disease in adults. We conducted a comprehensive search to identify studies examining the impact of sex on the pathophysiology of TR as well as treatment outcomes in patients with TR. We searched PUBMED/MEDLINE, SCOPUS, and Excerpta Medica dataBASE (EMBASE) from inception to September 2023 to identify relevant studies. Twelve studies totaling 22,574 patients met our eligibility criteria. These studies were categorized into three subgroups: patients with TR without intervention (3,848 patients, with 48.1% males and 51.9% females), those who underwent open heart surgery (17,498 patients: 46.2% males and 53.8% females), and those who underwent transcatheter tricuspid valve repair/replacement (TTVR; 1,687 patients: 41.6% males and 58.4% females). Analysis revealed no major differences in terms of TR etiology. Males tended to have a slightly lower mean age difference (mean difference (MD): -0.60 years; 95% confidence interval (CI) (-1.49, -0.04); p = 0.10) but had more frequent chronic lung disease (risk ratio (RR): 1.12, 95% CI (1.01, 1.25), p = 0.03). Males showed higher baseline TR volume (MD: 4.11, 95% CI (0.53, 7.68), p = 0.02) and lower left ventricular ejection fraction (MD: -5.85, 95% CI (-6.97, -4.73), p < 0.00001). Following open heart surgery for TR treatment, males required more frequent permanent pacemaker implantation (PPM; RR: 1.57, 95% CI (1.21, 2.03), p = 0.0006). Similarly, TTVR showed a higher need for PPM in males (RR: 1.45, 95% CI (1.10, 1.93), p = 0.010). In-hospital mortality exhibited no sex differences, but males had a slightly elevated late mortality risk. Sex differences in TR patients were notable in baseline characteristics, with males having a higher risk of certain conditions. The more frequent requirement for PPM was a major sex-based difference in terms of prognosis.

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“…20 Similarly, a study with 5582 patients from the Netherlands again found no statistical difference in in-hospital mortality based on sex for isolated or concomitant tricuspid valve surgery. 21 While several studies, such as those mentioned above, have focused on various subtypes of cardiac surgery such as CABGs, isolated valve (eg, aortic valve alone) repair or replacement, or percutaneous interventions, 19,22,23 our study is among the largest in scope to examine the association between patient sex and in-hospital mortality risk across multiple categories of open cardiac valve surgery.…”

Section: Discussionmentioning

confidence: 99%

Sex Differences in In-Hospital Mortality After Open Cardiac Valve Surgery

Bradley

White

Jiang

et al. 2022

Anesthesia &Amp; Analgesia

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BACKGROUND: Cardiac valvular disease affects millions of people worldwide and is a major cause of morbidity and mortality. Female patients have been shown to experience inferior clinical outcomes after nonvalvular cardiac surgery, but recent data are limited regarding open valve surgical cohorts. The primary objective of our study was to assess whether female sex is associated with increased in-hospital mortality after open cardiac valve operations. METHODS: Utilizing the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID), we conducted a retrospective cohort study of patients who underwent open cardiac valve surgery from 2007 to 2018 in Washington, Maryland, Kentucky, and Florida; from 2007 from to 2011 and from 2007 to 2016 in New York. The primary objective of this study was to estimate the confounder-adjusted association between sex and in-hospital mortality (as recorded and coded by SID HCUP) after open cardiac valve surgery. We used multilevel multivariable models to account for potential confounders, including intrahospital practice patterns. RESULTS: A total of 272,954 patients (108,443 women; 39.73% of sample population with mean age of 67.6 ± 14.3 years) were included in our analysis. The overall mortality rates were 3.8% for male patients and 5.1% for female patients. The confounder-adjusted odds ratio (OR) for in-hospital mortality for female patients compared to male patients was 1.41 (95% confidence interval [CI], 1.35-1.47; P < .001). When stratifying by surgical type, female patients were also at increased odds of in-hospital mortality (P < .001) in populations undergoing aortic valve replacement (adjusted OR [aOR], 1.38; 95% CI, 1.25-1.52); multiple valve surgery (aOR, 1.38; 95% CI ,1.22-1.57); mitral valve replacement (aOR, 1.22; 95% CI, 1.12-1.34); and valve surgery with coronary artery bypass grafting (aOR, 1.64; 95% CI, 1.54-1.74; all P < .001). Female patients did not have increased odds of in-hospital mortality in populations undergoing mitral valve repair (aOR, 1.26; 95% CI, 0.98-1.64; P = .075); aortic valve repair (aOR, 0.87; 95% CI, 0.67-1.14; P = .32); or any other single valve repair (aOR, 1.10; 95% CI, 0.82-1.46; P = .53). CONCLUSIONS: We found an association between female patients and increased confounderadjusted odds of in-hospital mortality after open cardiac valve surgery. More research is needed to better understand and categorize these important outcome differences. Future research should include observational analysis containing granular and complete patient-and surgeryspecific data. (Anesth Analg 2022;135:944-53) KEY POINTS• Question: Is female sex associated with increased in-hospital mortality after open cardiac valve surgery? • Findings: Relative to male patients, female patients showed an association with overall increased rates and confounder-adjusted odds of in-hospital death after multiple types of open cardiac valve surgeries. • Meaning: Female patients may be more likely to die in-hospital after cardiac valve surgery in the United Stat...

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Male–female differences in characteristics and early outcomes of patients undergoing tricuspid valve surgery: a national cohort study in the Netherlands

Cited by 8 publications

References 20 publications

Male-female differences in contemporary elective ascending aortic surgery: insights from the Netherlands Heart Registration

Male-female differences in contemporary elective ascending aortic surgery: insights from the Netherlands Heart Registration

Unveiling Sex Differences in Tricuspid Valve Disease: A Systematic Review and Meta-Analysis of Surgical Management

Sex Differences in In-Hospital Mortality After Open Cardiac Valve Surgery

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