Women exhibit a mortality rate of 21% within 30 days following surgery for mitral or aortic valve endocarditis, a figure significantly higher than the 11% recorded in men. This disparity persists even after accounting for patients' clinical characteristics, according to research from the Cardiovascular Diseases and Infectious Diseases groups at VHIR.
The study, based on the analysis of 1,085 patients (239 women), emphasizes the need to delve into the causes of this disparity to improve surgical outcomes. Infective endocarditis, an inflammation of the heart's inner lining and valves, may necessitate surgery to repair or replace the affected valve, particularly in severe cases or those with complications. In Catalonia, an estimated 100 to 120 such interventions are performed annually.
Marco Tomasino, lead researcher of the study, notes that surgery carries considerable risk, especially when urgent, and highlights the importance of accurately assessing individual patient risk. The research is part of the international prospective registry BESOS (Barcelona Endocarditis Surgery Outcome Score), initiated by Vall d'Hebron, which collects data from 55 centers across 19 countries.
Observed differences between sexes include a higher frequency of Staphylococcus aureus infection and mitral valve involvement in women, while men more commonly presented with Enterococcus faecalis infection and aortic valve involvement. Greater frailty was also noted among female patients.
Dr. Núria Fernández-Hidalgo, head of the Multidisciplinary Committee for Infective Endocarditis at the Vall d'Hebron University Hospital, points out that the mortality difference persists even after adjusting for baseline factors. The research team is exploring hypotheses such as delayed diagnosis or different biological responses to surgery and extracorporeal circulation in women.
Dr. Ignacio Ferreira, head of the Cardiology Department at Vall d'Hebron, states that future studies will analyze the care pathway to identify high-risk patients and develop specific strategies. Concurrently, a new prognostic score is being developed for more personalized decision-making and patient follow-up.
