Delays in Heart Surgery for Women due to One-Size-Fits-All Criteria

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Two studies showed similar disparities for different heart procedures. Read the full article.

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Welcome to Health Lab, your destination for news and stories about the future of healthcare. 

Today: Recent studies find that women may face heart surgery delays due to surgical criteria based on male anatomy. Two studies showed similar disparities for different heart procedures.

Researchers found that the size thresholds surgeons use to determine whether to move forward with certain operations do not consider smaller female cardiac structures — which may result in heart surgery delays for women.

Catherine M. Wagner, M.D., first author of both studies and integrated thoracic surgery resident at the University of Michigan Health Frankel Cardiovascular Center says, “Most size thresholds for surgical intervention are absolute, and our findings suggest that this may contribute to women undergoing surgery later and sicker, or being less likely to receive recommended surgical therapy. The results highlight a need for sex-specific guideline criteria, or criteria that account for differing body size, to improve timely intervention on women with cardiovascular disease and ultimately improve outcomes.

In the first of two studies, U-M researchers investigated thousands mitral valve surgery cases between mid-2014 and 2023 using the Society of Thoracic Surgeons national database.

They focused on the mitral valve surgery patients who also experienced leaking, or regurgitation, from their tricuspid valve.

Some patients are recommended to have the tricuspid valve repaired during the same procedure depending on the severity of the leakage and if their tricuspid annulus is dilated beyond a size threshold of 40 mm.

Results published in the Journal of the American College of Cardiology reveal that women were more likely to have severe tricuspid regurgitation than men but less likely to undergo repair.

A reason for this, researchers believe, is because women had smaller absolute tricuspid annulus dilation compared to men.

Steven F. Bolling, senior author and professor of cardiac surgery at University of Michigan Medical School says, “There was no difference in the rate of who received tricuspid repair when the tricuspid annulus reached the standard surgical threshold of 40 mm, but we are seeing that using an absolute diameter across all patients may be inadequate.”

The second paper, published in Heart, assessed patients who underwent spontaneous repair for acute type A aortic dissection, which is a potentially fatal tear in the wall of the body’s largest artery.

Women who experienced dissection had a smaller diameter of the ascending aorta than men, but presented with a larger diameter compared to their body size.

The current size threshold for preventive repair of ascending aortic aneurysm — which is a common cause of aortic emergencies, including dissection, rupture and death — is the same across both sexes at 50 mm.

Women in this study, however, were nearly three times more likely to experience dissection at sizes below that range.

Barbara C.S. Hamilton, M.D., M.S., senior author of the paper and the Cheryl Huey, M.D., Early Career Professor of Cardiac Surgery at U-M Medical School say, “Our study builds on mounting evidence that sex-agnostic repair guidelines for aortic dissection may inadvertently disadvantage females, leading to a higher rate of preventable aortic complications among women.”

For abdominal aortic aneurysm, which can also lead to dissection but is a less common cause, similar studies have led to sex-specific intervention guidelines.

Wagner says, “This is one of many opportunities across cardiac surgery to evaluate whether guidelines tailored by sex​ or body-size​ could narrow longstanding sex disparities in cardiovascular disease.”

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