{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T20:29:50Z","timestamp":1790800190116,"version":"4.1.0"},"reference-count":39,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2024,8,14]],"date-time":"2024-08-14T00:00:00Z","timestamp":1723593600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"Edwards Lifesciences, Medtronic, Abbott and Artivion. S.M"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,9,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>OBJECTIVES<\/jats:title>\n                  <jats:p>Degenerative mitral regurgitation is associated with heart failure, arrhythmia and mortality. The impact of sex on timing of surgical referral and outcomes has not been reported comprehensively. We examined preoperative status and surgical outcomes of male versus female degenerative mitral valve regurgitation patients undergoing surgery.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>We reviewed our institutional database for all patients undergoing surgery for degenerative mitral regurgitation between 2013 and 2021. Preoperative clinical and echocardiographic variables, surgical characteristics and outcomes were compared, and left atrial strain in available images.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>Of 963 patients, 314 (32.6%) were female. Women were older (67 vs 64\u2009years, P\u2009=\u20090.031) and more often had bileaflet prolapse (19.4% vs 13.8%, P\u2009=\u20090.028), mitral annular calcification (12.1% vs 5.4%, P\u2009&amp;lt;\u20090.001) and tricuspid regurgitation (TR; 31.8% vs 22.5%, P\u2009=\u20090.001). Indexed left ventricular end-diastolic and end-systolic diameters were higher in women, with 29.4 vs 26.7\u2009mm\/m2 (P\u2009&amp;lt;\u20090.001) and 18.2 vs 17\u2009mm\/m2 (P\u2009&amp;lt;\u20090.001), respectively, and left atrial conduit strain lower (17.6% vs, 21.2%, P\u2009=\u20090.001). Predicted risk of mortality was 0.73% vs 0.54% in men (P\u2009=\u20090.023). Women required mechanical circulatory support more frequently (1.3% vs 0%, P\u2009=\u20090.011), had longer intensive care unit stay (29 vs 26\u2009h, P\u2009&amp;lt;\u20090.001), mechanical ventilation (5.4 vs 5\u2009h, P\u2009=\u20090.036), and overall hospitalization (7 vs 6\u2009days, P\u2009&amp;lt;\u20090.001). There was no difference in long-term reoperation-free survival (P\u2009=\u20090.35).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>Women undergoing mitral valve repair are older and show indicators of more advanced disease with long-standing left ventricular impairment. Guidelines may need to be adjusted and address this disparity, to improve postoperative recovery times and outcomes.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ejcts\/ezae312","type":"journal-article","created":{"date-parts":[[2024,8,13]],"date-time":"2024-08-13T22:25:41Z","timestamp":1723587941000},"source":"Crossref","is-referenced-by-count":9,"title":["Presentation and outcomes of women and men undergoing surgery for degenerative mitral regurgitation"],"prefix":"10.1093","volume":"66","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4412-6337","authenticated-orcid":false,"given":"Antonia","family":"van Kampen","sequence":"first","affiliation":[{"name":"Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School , Boston, MA, USA"},{"name":"University Clinic of Cardiac Surgery, Leipzig Heart Center , Leipzig, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie","family":"Butte","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School , Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dane C","family":"Paneitz","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School , Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasufumi","family":"Nagata","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Echocardiography Laboratory, Massachusetts General Hospital, Harvard Medical School , Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathaniel B","family":"Langer","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School , Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1046-1364","authenticated-orcid":false,"given":"Michael A","family":"Borger","sequence":"additional","affiliation":[{"name":"University Clinic of Cardiac Surgery, Leipzig Heart Center , Leipzig, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David A","family":"D\u2019Alessandro","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School , Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thoralf M","family":"Sundt","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School , Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serguei","family":"Melnitchouk","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School , Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,8,14]]},"reference":[{"key":"2024090222022756700_ezae312-B1","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1038\/nrcardio.2015.161","article-title":"Mitral valve disease\u2014morphology and mechanisms","volume":"12","author":"Levine","year":"2015","journal-title":"Nat Rev Cardiol"},{"key":"2024090222022756700_ezae312-B2","doi-asserted-by":"crossref","first-page":"794","DOI":"10.1016\/j.athoracsur.2019.07.014","article-title":"Degenerative mitral valve repair restores life expectancy","volume":"109","author":"Watt","year":"2020","journal-title":"Ann Thorac Surg"},{"key":"2024090222022756700_ezae312-B3","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1016\/j.jcmg.2016.02.017","article-title":"Comprehensive imaging in women with organic mitral regurgitation: implications for clinical outcome","volume":"9","author":"Mantovani","year":"2016","journal-title":"JACC Cardiovasc Imaging"},{"key":"2024090222022756700_ezae312-B4","doi-asserted-by":"crossref","first-page":"1355","DOI":"10.1161\/01.CIR.0000028933.34260.09","article-title":"Natural history of asymptomatic mitral valve prolapse in the community","volume":"106","author":"Avierinos","year":"2002","journal-title":"Circulation"},{"key":"2024090222022756700_ezae312-B5","doi-asserted-by":"crossref","first-page":"787","DOI":"10.7326\/0003-4819-149-11-200812020-00003","article-title":"Sex differences in morphology and outcomes of mitral valve prolapse","volume":"149","author":"Avierinos","year":"2008","journal-title":"Ann Intern Med"},{"key":"2024090222022756700_ezae312-B6","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1093\/icvts\/ivab090","article-title":"Does gender bias affect outcomes in mitral valve surgery for degenerative mitral regurgitation?","volume":"33","author":"Kandula","year":"2021","journal-title":"Interact Cardiovasc Thorac Surg"},{"key":"2024090222022756700_ezae312-B7","doi-asserted-by":"crossref","first-page":"E276","DOI":"10.1532\/HSF98.20111030","article-title":"Sex differences in procedure selection and outcomes of patients undergoing mitral valve surgery","volume":"14","author":"Vassileva","year":"2011","journal-title":"Heart Surg Forum"},{"key":"2024090222022756700_ezae312-B8","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1093\/ehjci\/jey042","article-title":"Standardization of left atrial, right ventricular, and right atrial deformation imaging using two-dimensional speckle tracking echocardiography: a consensus document of the EACVI\/ASE\/Industry Task Force to standardize deformation imaging","volume":"19","author":"Badano","year":"2018","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"2024090222022756700_ezae312-B9","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1016\/j.pcad.2017.11.005","article-title":"Assessment of the severity of native mitral valve regurgitation","volume":"60","author":"El-Tallawi","year":"2017","journal-title":"Prog Cardiovasc Dis"},{"key":"2024090222022756700_ezae312-B10","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1016\/j.athoracsur.2019.07.029","article-title":"Minimally invasive nonresectional mitral valve repair can be performed with excellent outcomes","volume":"109","author":"Axtell","year":"2020","journal-title":"Ann Thorac Surg"},{"key":"2024090222022756700_ezae312-B11","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1186\/1471-2288-12-81","article-title":"To test or not to test: preliminary assessment of normality when comparing two independent samples","volume":"12","author":"Rochon","year":"2012","journal-title":"BMC Med Res Methodol"},{"key":"2024090222022756700_ezae312-B12","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"370","author":"von Elm","year":"2007","journal-title":"Lancet"},{"key":"2024090222022756700_ezae312-B13","author":"R-Team","year":"2020"},{"key":"2024090222022756700_ezae312-B14","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1093\/eurheartj\/ehab395","article-title":"2021 ESC\/EACTS Guidelines for the management of valvular heart disease","volume":"43","author":"Vahanian","year":"2021","journal-title":"Eur Heart J"},{"key":"2024090222022756700_ezae312-B15","first-page":"e35","article-title":"2020 ACC\/AHA guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"143","author":"Otto","year":"2021","journal-title":"Circulation"},{"key":"2024090222022756700_ezae312-B16","doi-asserted-by":"crossref","first-page":"1172","DOI":"10.1161\/CIRCULATIONAHA.121.056025","article-title":"Cardiac surgery in women in the current era: what are the gaps in care?","volume":"144","author":"Cho","year":"2021","journal-title":"Circulation"},{"key":"2024090222022756700_ezae312-B17","doi-asserted-by":"crossref","first-page":"1396","DOI":"10.1016\/j.echo.2019.08.012","article-title":"Similarities and differences in left ventricular size and function among races and nationalities: results of the world alliance societies of echocardiography normal values study","volume":"32","author":"Asch","year":"2019","journal-title":"J Am Soc Echocardiogr"},{"key":"2024090222022756700_ezae312-B18","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1080\/24748706.2021.1968089","article-title":"The clinical implications of body surface area as a poor proxy for cardiac output","volume":"5","author":"Vriesendorp","year":"2021","journal-title":"Structural Heart"},{"key":"2024090222022756700_ezae312-B19","doi-asserted-by":"crossref","first-page":"e022332","DOI":"10.1161\/JAHA.121.022332","article-title":"Mitral valve prolapse induces regionalized myocardial fibrosis","volume":"10","author":"Morningstar","year":"2021","journal-title":"J Am Heart Assoc"},{"key":"2024090222022756700_ezae312-B20","doi-asserted-by":"crossref","first-page":"e0271588","DOI":"10.1371\/journal.pone.0271588","article-title":"Left atrial remodeling in mitral regurgitation: a combined experimental-computational study","volume":"17","author":"Bouwmeester","year":"2022","journal-title":"PLoS One"},{"key":"2024090222022756700_ezae312-B21","doi-asserted-by":"crossref","first-page":"3510","DOI":"10.3390\/jcm11123510","article-title":"Decreased peak left atrial longitudinal strain is associated with persistent pulmonary hypertension associated with left heart disease","volume":"11","author":"Lee","year":"2022","journal-title":"J Clin Med"},{"key":"2024090222022756700_ezae312-B22","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1111\/j.1540-8175.2010.01329.x","article-title":"Chronic mitral regurgitation: left atrial deformation analysis by two-dimensional speckle tracking echocardiography","volume":"28","author":"Cameli","year":"2011","journal-title":"Echocardiography"},{"key":"2024090222022756700_ezae312-B23","doi-asserted-by":"crossref","first-page":"1597","DOI":"10.1007\/s10554-019-01598-6","article-title":"Prognostic value of left atrial strain in patients with moderate asymptomatic mitral regurgitation","volume":"35","author":"Cameli","year":"2019","journal-title":"Int J Cardiovasc Imaging"},{"key":"2024090222022756700_ezae312-B24","doi-asserted-by":"crossref","first-page":"e024814","DOI":"10.1161\/JAHA.121.024814","article-title":"Incremental prognosis by left atrial functional assessment: the left atrial coupling index in patients with floppy mitral valves","volume":"11","author":"Essayagh","year":"2022","journal-title":"J Am Heart Assoc"},{"key":"2024090222022756700_ezae312-B25","doi-asserted-by":"crossref","first-page":"1918","DOI":"10.1093\/eurheartj\/ehaa192","article-title":"Functional tricuspid regurgitation of degenerative mitral valve disease: a crucial determinant of survival","volume":"41","author":"Essayagh","year":"2020","journal-title":"Eur Heart J"},{"key":"2024090222022756700_ezae312-B26","doi-asserted-by":"crossref","first-page":"ezad104","DOI":"10.1093\/ejcts\/ezad104","article-title":"Left atrial function and not volume predicts mid-to-late atrial fibrillation after mitral valve repair","volume":"63","author":"van Kampen","year":"2023","journal-title":"Eur J Cardiothorc Surg"},{"key":"2024090222022756700_ezae312-B27","doi-asserted-by":"crossref","first-page":"983","DOI":"10.1016\/j.echo.2018.03.011","article-title":"Left atrial function is associated with earlier need for cardiac surgery in moderate to severe mitral regurgitation: usefulness in targeting for early surgery","volume":"31","author":"Ring","year":"2018","journal-title":"J Am Soc Echocardiogr"},{"key":"2024090222022756700_ezae312-B28","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1016\/j.athoracsur.2019.10.044","article-title":"Predictors of Left Ventricular Dysfunction After Surgery for Degenerative Mitral Regurgitation","volume":"109","author":"Kislitsina","year":"2020","journal-title":"Ann Thorac Surg"},{"key":"2024090222022756700_ezae312-B29","doi-asserted-by":"crossref","first-page":"1430","DOI":"10.1177\/2047487319848186","article-title":"Gender difference in mitral valve disease: where is the bias?","volume":"26","author":"Marsan","year":"2019","journal-title":"Eur J Prev Cardiol"},{"key":"2024090222022756700_ezae312-B30","doi-asserted-by":"crossref","first-page":"2385","DOI":"10.1016\/S0140-6736(21)00684-X","article-title":"The Lancet women and cardiovascular disease commission: reducing the global burden by 2030","volume":"397","author":"Vogel","year":"2021","journal-title":"Lancet"},{"key":"2024090222022756700_ezae312-B31","doi-asserted-by":"crossref","first-page":"1833","DOI":"10.1016\/j.athoracsur.2016.08.076","article-title":"Valve repair is superior to replacement in most patients with coexisting degenerative mitral valve and coronary artery diseases","volume":"103","author":"Javadikasgari","year":"2017","journal-title":"Ann Thorac Surg"},{"key":"2024090222022756700_ezae312-B32","doi-asserted-by":"crossref","first-page":"1433","DOI":"10.1177\/2047487319833307","article-title":"Is mitral valve disease treated differently in men and women?","volume":"26","author":"Kislitsina","year":"2019","journal-title":"Eur J Prev Cardiol"},{"key":"2024090222022756700_ezae312-B33","first-page":"42","article-title":"Gender differences in mitral valve surgery","volume":"61","author":"Seeburger","year":"2013","journal-title":"Thorac Cardiovasc Surg"},{"key":"2024090222022756700_ezae312-B34","doi-asserted-by":"crossref","first-page":"904","DOI":"10.1016\/j.ahj.2013.08.015","article-title":"Risk factors associated with the incidence and progression of mitral annulus calcification: the multi-ethnic study of atherosclerosis","volume":"166","author":"Elmariah","year":"2013","journal-title":"Am Heart J"},{"key":"2024090222022756700_ezae312-B35","doi-asserted-by":"crossref","first-page":"1867","DOI":"10.1016\/j.amjcard.2014.03.013","article-title":"Prevalence of calcification of the mitral valve annulus in patients undergoing surgical repair of mitral valve prolapse","volume":"113","author":"Fusini","year":"2014","journal-title":"Am J Cardiol"},{"key":"2024090222022756700_ezae312-B36","doi-asserted-by":"crossref","first-page":"1379","DOI":"10.1016\/j.jtcvs.2013.11.030","article-title":"Minimally invasive mitral valve repair in Barlow\u2019s disease: early and long-term results","volume":"148","author":"Borger","year":"2014","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2024090222022756700_ezae312-B37","first-page":"768","article-title":"Barlow\u2019s mitral valve disease: results of conventional and minimally invasive repair approaches","volume":"2","author":"Melnitchouk","year":"2013","journal-title":"Annals of Cardiothoracic Surgery"},{"key":"2024090222022756700_ezae312-B38","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1007\/s00508-019-01603-x","article-title":"Gender-specific differences in valvular heart disease","volume":"132","author":"Nitsche","year":"2020","journal-title":"Wien Klin Wochenschr"},{"key":"2024090222022756700_ezae312-B39","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1016\/j.athoracsur.2022.12.024","article-title":"Risk of surgical mitral valve repair for primary mitral regurgitation","volume":"115","author":"Badhwar","year":"2023","journal-title":"Ann Thorac Surg"}],"container-title":["European Journal of Cardio-Thoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ejcts\/advance-article-pdf\/doi\/10.1093\/ejcts\/ezae312\/58819833\/ezae312.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ejcts\/article-pdf\/66\/3\/ezae312\/58998078\/ezae312.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ejcts\/article-pdf\/66\/3\/ezae312\/58998078\/ezae312.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,9,2]],"date-time":"2024-09-02T22:03:54Z","timestamp":1725314634000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ejcts\/article\/doi\/10.1093\/ejcts\/ezae312\/7733569"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,14]]},"references-count":39,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2024,9,2]]}},"URL":"https:\/\/doi.org\/10.1093\/ejcts\/ezae312","relation":{},"ISSN":["1873-734X"],"issn-type":[{"value":"1873-734X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2024,9]]},"published":{"date-parts":[[2024,8,14]]},"article-number":"ezae312"}}