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Eur J Cardiothorac Surg. 2016 Sep;50(3):482-7. doi: 10.1093/ejcts/ezw151. Epub 2016 May 12.

Male-female differences and survival in patients undergoing isolated mitral valve surgery: a nationwide cohort study in the Netherlands.

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Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands.
Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, Netherlands.
Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, Netherlands.
Department of Cardiothoracic Surgery, Free University Medical Center, Amsterdam, Netherlands.
Department of Congenital Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands.
Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands.



The objective of this study was to compare male-female differences with respect to baseline characteristics and short-term outcome in a contemporary nationwide cohort of patients who underwent isolated mitral valve (MV) surgery.


All patients [N = 3411; 58% males (N = 1977)] who underwent isolated MV surgery (replacement: N = 1048, 31%; reconstruction: N = 2364, 69%) in the Netherlands between January 2007 and December 2011 were included in this study. Differences in patient and procedural characteristics and in-hospital outcome were compared between male and female patients.


Female patients were generally older (mean age, 64 vs 61 years, P < 0.001), presented more often with pulmonary hypertension (P = 0.03) and had higher logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) I (P < 0.001). Male patients presented more often with prior coronary artery bypass graft surgery (P < 0.001) and active endocarditis (P = 0.002). Female patients underwent MV replacement more often (P < 0.001) and, in case of replacement, received stented bioprostheses more often (P < 0.001). In-hospital mortality rates after MV replacement were 7% (n = 33) and 7% (n = 40) in male and female patients, respectively (OR 1.08, 95% CI 0.67-1.75; P = 0.75). In-hospital mortality rates after MV reconstruction were 1.4% (n = 21) and 1.3% (n = 11) in male and female patients, respectively (OR 0.88, 95% CI 0.42-1.84; P = 0.74).


There are substantial male-female differences in patient presentation and procedural aspects in isolated MV surgery in the Netherlands. Female patients are older, have more severe disease at the time of surgery and undergo valve repair less often. Future studies are needed to identify potentially modifiable patient factors to improve the outcome of female patients with MV disease.


EuroSCORE; Gender; Mitral valve; Outcome

[Indexed for MEDLINE]

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