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Background: Tricuspid valve (TV) disease is more common in women. Surgery is the only definitive treatment for TV disease; however it is associated with high mortality. We sought to determine if gender is associated with differences in procedural characteristics or mortality.
Methods: The National Inpatient Sample (NIS) was used to identify patients >18 years old who underwent isolated TV surgery from 2004-2013. Results were weighted to represent national averages. Patients with congenital heart disease and endocarditis were excluded. Men and women were propensity-score matched and outcomes were assessed using McNemar's test.
Results: 5005 patients underwent isolated TV surgery during the study period, of which 57.5% were women. Women were more likely to be hypertensive (51.9% vs. 45.5%; p=0.04) and have prior valve surgery (12.5% vs. 5.2%; p<0.001). Men were more likely to have coronary disease (28.7% vs. 40.3%; p<0.001), chronic kidney disease (15.4% vs. 23.8%; p<0.001), and prior bypass surgery (2.2% vs. 4.8%; p=0.02). Women were more likely to undergo TV replacement (60.3% vs 57.7%, p=0.02), and to receive a mechanical valve (41.2% vs 36.4%; p=0.008). Propensity-score matching resulted in two groups of 366 women and men with similar characteristics. Overall in-hospital mortality was similar for matched women and men (7.7% vs. 7.9%; p=0.99). Women showed a trend towards a higher utilization of blood transfusion (38.5% vs. 34.4%; p=0.30) and a lower rate of acute kidney injury (25.4% vs. 30.9%; p=0.12) with similar rates of requiring dialysis (4.1% vs. 4.1%; p=0.99). Women were more likely discharged to a skilled nursing facility (21.6% vs. 19.4%; p=0.62). The median cost of hospitalization was significantly lower for women ($155k vs. $166k; p=0.04) despite a similar length of stay.
Conclusions: TV surgery is more common in women, particularly mechanical TV replacement. Overall mortality in men and women was similar, however important differences were observed including a lower cost of hospitalization and a greater likelihood of discharging to a nursing home. These findings have important clinical implications as they may guide risk stratification in women being considered for TV surgery.
Moderated Poster Contributions
Valvular Heart Disease Moderated Poster Theater, Poster Hall, Hall C
Saturday, March 18, 2017, 10:00 a.m.-10:10 a.m.
Session Title: Sex Disparity in VHD Outcomes
Abstract Category: 37. Valvular Heart Disease: Therapy
Presentation Number: 1209M-05
- 2017 American College of Cardiology Foundation