Abstract
(1) Background: Mitral regurgitation (MR) is the second most prevalent valvular heart disease in developed countries. Mitral valve (MV) disease is a common cause of heart failure and a leading cause of morbidity and mortality in the U.S.A. and Europe. (2) Methods: We performed a retrospective study using the Spanish National Hospital Discharge Database, 2001–2015. We included patients that had surgical mitral valve replacement (SMVR) listed as a procedure in their discharge report. We sought to (i) examine trends in incidence of SMVR among women and men in Spain, (ii) compare in-hospital outcomes for mechanical and bioprosthetic SMVR by sex, and (iii) identify factors associated with in-hospital mortality (IHM) after SMVR. (3) Results: We identified 44,340 hospitalizations for SMVR (84% mechanical, 16% bioprosthetic). The incidence of SMVR was higher in women (IRR 1.51; 95% CI 1.48–1.54). The use of mechanical SMVR decreased over time in both sexes and the use of bioprosthetic valves increased over time in both sexes. Men who underwent mechanical and bioprosthetic SMVR had higher comorbidity than women. IHM was significantly lower in women who underwent SMVR than in men (10% vs. 12% p < 0.001 for mechanical and 14% vs. 16% p = 0.025 for bioprosthetic valve, respectively). Major adverse cardiovascular and cerebrovascular events (MACCE) were also significantly lower in women who underwent mechanical and bioprosthetic SMVR. A significant reduction in both in-hospital MACCEs and IHM was observed over the study period regardless of sex. After multivariable logistic regression, male sex was associated with increased IHM only in bioprosthetic SMVR (OR 1.28; 95% CI 1.1–1.5). (4) Conclusions: This nationwide analysis over 15 years of sex-specific outcomes after SMVR showed that incidences are significantly higher in women than men for mechanical and bioprosthetic SMVR. IHM and MACCE have improved over time for SMVR in both sexes. Male sex was independently associated with higher mortality after bioprosthetic SMVR.
Highlights
Mitral regurgitation (MR) is the second most prevalent valvular heart disease in developed countries [1]
We sought to (i) examine trends in incidence of surgical mitral valve replacement (SMVR) among women and men in Spain, (ii) compare in-hospital outcomes for mechanical and bioprosthetic SMVR by sex, and (iii) identify factors associated with in-hospital mortality (IHM) after SMVR. (3) Results: We identified 44,340 hospitalizations for SMVR (84% mechanical, 16% bioprosthetic)
The use of mechanical SMVR decreased over time in both sexes and the use of bioprosthetic valves increased over time in both sexes
Summary
Mitral regurgitation (MR) is the second most prevalent valvular heart disease in developed countries [1]. MR is classified into primary MR, most commonly degenerative, and secondary (functional) MV regurgitation, in which ischemic or non-ischemic dilatation of the left ventricle or mitral annulus leads to abnormal geometry with consequent insufficiency [4] These entities represent different disease processes, have different treatment approaches, and different prognoses. Valve repair for primary MR represents the gold standard with established high-quality results in reference centers [5], whereas in functional regurgitation, MVR is associated with high failure rates with progressive ventricular dysfunction There are cases in which the mitral valve is not repairable, and replacement is a safer option. Jamieson et al [6] concluded that porcine bioprosthesis is satisfactory for implantation in patients older than 70 years of age but not in younger patients
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