Gender affects outcome of heart valve surgery
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Men and women have different long-term outcomes after surgery to replace a defective heart valve, according to a report by Canadian researchers.
Valves play a critical role in making sure that blood flows only one way through the heart. Of the four valves present in the heart, the mitral and aortic valves are, by far, the ones most commonly replaced.
The mitral valve prevents blood that has come into the left ventricle, the main pumping chamber of the heart, from backing up into the blood vessels of the lungs, whereas the aortic valve stops blood that has just been pumped out of the heart from flowing back in.
Conditions that do not allow the valves to open fully or that prevent them from closing completely can be a reason for surgical replacement. The new valve is made of either a mechanical material, such as plastic or metal, or a biological material from an animal or donated human heart.
Although outcomes of other heart surgeries have been shown to differ by gender, there was little information regarding the impact on outcomes after heart valve replacement, according to Dr. Marc Ruel and colleagues from the University of Ottawa in Ontario.
In their study of 1261 women and 1857 men who had aortic or mitral valve replacements, women who underwent aortic valve replacement with a biologic device were less likely to require re-operation than their male peers. Gender had no bearing on the risk of re-operation for any other combinations of valve surgery and device material.
Women were more likely than men to experience a stroke after undergoing mechanical aortic valve replacement and possibly also after biological and mechanical mitral valve replacement, the team reports in the medical journal Heart.
However, women had better long-term survival than men after biological aortic valve replacement and possibly also after biologic and mechanical mitral valve replacement, the researchers note.
“Further investigation to verify and explore the (cause) of these differences is warranted,” the investigators say. “We believe the present study will help to more accurately describe the long-term results after valve replacement surgery for women and men, especially in an era where more women than ever are being referred for cardiac surgery.”
SOURCE: Heart, February 2009.
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