Sex Differences in Epidemiological Distribution and Outcomes of Surgical Mitral Valve Disease

Feng Cheng Chang, Chun Yu Chen, Yi Hsin Chan, Yu Ting Cheng, Chia Pin Lin, Victor Chien Chia Wu, Kuo Chun Hung, Pao-Hsien Chu, An Hsun Chou, Shao Wei Chen*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review


BACKGROUND: Mitral valve (MV) disease is the most common form of valvular heart disease. Findings that indicate women have a higher risk for unfavorable outcomes than men remain controversial. This study aimed to determine the sex-based differences in epidemiological distributions and outcomes of surgery for MV disease.Methods and Results: Overall, 18,572 patients (45.3% women) who underwent MV surgery between 2001 and 2018 were included. Outcomes included in-hospital death and all-cause mortality during follow up. Subgroup analysis was conducted across different etiologies, including infective endocarditis (IE), degenerative, ischemic, and rheumatic mitral pathology. The overall MV repair rate was lower in women than in men (20.5% vs. 30.6%). After matching, 6,362 pairs (woman : man=1 : 1) of patients were analyzed. Women had a slightly higher risk for in-hospital death than men (10.8% vs. 9.8%; odds ratio [OR]: 1.11, 95% confidence interval [CI]: 0.99-1.24; P=0.075). Women tended to have a higher incidence of de novo dialysis (9.8% vs. 8.6%; P=0.022) and longer intensive care unit stay (8 days vs. 7.1 days; P<0.001). Women with IE had poorer in-hospital outcomes than men; however, there were no sex differences in terms of all-cause mortality.

CONCLUSIONS: Sex-based differences of MV intervention still persist. Although long-term outcomes were comparable between sexes, women, especially those with IE, had worse perioperative outcomes than men.

Original languageEnglish
Pages (from-to)579-588
Number of pages10
JournalCirculation Journal
Issue number4
StatePublished - 25 03 2024
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2024 Japanese Circulation Society. All rights reserved.


  • Mitral valve surgery
  • Mortality
  • Sex differences
  • Women
  • Hospital Mortality
  • Endocarditis, Bacterial/surgery
  • Humans
  • Male
  • Treatment Outcome
  • Sex Characteristics
  • Mitral Valve/surgery
  • Heart Valve Prosthesis Implantation/adverse effects
  • Endocarditis
  • Heart Valve Diseases/epidemiology
  • Female
  • Retrospective Studies
  • Mitral Valve Insufficiency/epidemiology
  • Renal Dialysis


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