Two studies that show female patients undergoing heart surgery are less likely to have secondary conditions corrected during a procedure have promoted a call for surgeons to tackle the disparity.
New evidence suggests that associated procedures are not happening despite guidelines, with one study author urging an investigation into the barriers faced by female patients.
The first study examined 5,000-plus patients with atrial fibrillation who underwent heart bypass or aortic valve replacement surgery at nearly three dozen Michigan hospitals between 2014 and 2022.
The Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative gathered the data.
While guidelines recommend repair of atrial fibrillation during cardiac surgery, female patients with preoperative Afib were 26% less likely to have it corrected during the procedure after adjusting for factors such as demographics and comorbidities.
According to results published in the Journal of Cardiovascular and Thoracic Surgery, 67% of male patients received the simultaneous Afib procedure compared to 59% of females.
Atrial fibrillation is among the most common comorbidities seen among cardiac surgery patients. Women are more likely to experience Afib complications, including stroke.
The first author of both papers, Catherine M. Wagner, an integrated thoracic surgery resident at the University of Michigan Health, said: ‘Across the spectrum of cardiovascular care, from medical management to transcatheter and surgical procedures, there is growing evidence that women are undertreated. Our work highlights opportunities to improve guideline-recommended care in a way that reduces existing disparities.’
Senior author Robert B Hawkins, a cardiac surgeon at the U-M Health Frankel Cardiovascular Centre and assistant professor of cardiac surgery at U-M Medical School, urged: ‘We must investigate the barriers to female patients receiving this recommended treatment. Prior work has found that additional Afib procedures, such as left atrial appendage management, do not increase morbidity and mortality during cardiac surgery. The disparity we observed may be related to overall low rates of adoption of such Afib procedures by doctors and hospitals, as well as surgeon perception of a higher risk existing among women.’
In the second study, a Wagner-led team examined nearly 400 people who received mitral valve surgery between 2014 and 2023. Those patients also had moderate to severe tricuspid valve leaking, or regurgitation, at the time of surgery.
Results published in Annals of Thoracic Surgery reveal that women were 52% less likely than men to receive tricuspid valve repair during their mitral surgery.
Three-quarters of the male patients had the repair done compared to 57% of female patients.
Using a risk model, researchers also found that female patients were more likely to have severe tricuspid regurgitation or to require a valve-related reoperation up to four years later.
Senior author Steven F Bolling, professor of cardiac surgery at the University of Michigan Medical School, said: ‘Taken together, these data suggest that undertreatment of women with moderate or worse tricuspid regurgitation who are undergoing degenerative mitral surgery may be contributing to their worse outcomes. This undertreatment occurred even though additional tricuspid repair is a class I recommendation during left-sided valve surgery. We must advance the equitable use of the guideline-recommended treatment for this procedure.’
