Is Late Left Ventricle Remodeling After Repair of Degenerative Mitral Regurgitation Worse in Women?

Abstract

Recent data suggest sex-specific differences in left ventricle (LV) remodeling in patients with ventricular dysfunction or volume overload. Data describing LV remodeling in patients after repair of degenerative mitral regurgitation (MR) is scarce. Between 2002 and 2017, 1012 patients underwent repair of MR due to myxomatous degeneration and were monitored serially in a dedicated clinic. Patients were a mean age of 63.8 ± 12.7 years, and 277 (27%) were women. Mean preoperative indexed LV end-systolic dimension was 19.0 ± 4.3 mm/m2. Clinical and echocardiographic follow-up averaged 5.1 years and extended to 14.7 years. There were 3112 postoperative echocardiograms performed for these patients. Overall, freedom from recurrent MR exceeding 2+ was 98.3% ± 5.5% at 5 years and 86.9% ± 2.0% at 10 years. After a mean of 5.1 years, the mean postoperative indexed LV end-systolic dimension was 17.3 ± 4.2 mm/m2. Postoperative indexed LV end-systolic dimension decreased compared with their preoperative measurement in 63% of patients. Notably, women were less likely to experience a postoperative decrease in indexed LV end-systolic dimension than men (hazard ratio, 0.7 ± 0.1; P= .04), even after adjusting for differences in age, preoperative atrial fibrillation status, preoperative right ventricle systolic pressure, and the subsequent development of recurrent MR. Similar results were also obtained in a propensity analysis of 275 matched female-male pairs (hazard ratio, 0.7 ± 0.1; P= .03). Few data are available describing LV remodeling after repair of degenerative MR. In a large population registry, we have observed sex-specific differences in late LV remodeling. These data therefore raise equipoise that earlier surgical intervention of women with degenerative MR may be warranted.