Doctors less likely to address secondary condition in women during heart surgery

You're getting heart surgery, but your surgeon notices a new anomaly that perhaps could be fixed at the same time.

That's more likely to happen if you're a man than a woman, new studies find.

The findings came as little surprise to lead researcher Dr. Catherine Wagner , an integrated thoracic surgery resident at University of Michigan (UM) Health.

"Across the spectrum of cardiovascular care, from medical management to transcatheter and surgical procedures, there is growing evidence that women are under-treated," she said in a UM news release.

In one of the studies, Wagner's team focused on atrial fibrillation (a-fib), a common irregular heartbeat that can greatly raise a person's risk for stroke if it's not treated.

Her team looked at about 5,000 people with a-fib who'd also undergone heart bypass or aortic valve replacement surgery at one of nearly three dozen Michigan hospitals between 2014 and 2022.

Even though cardiology guidelines recommend that a-fib be repaired during a cardiac surgery, this only happened 59% of the time for the female patients versus 67% of the time for males, the study found.

Put another way, that means that women are 26% less likely than men to get this "secondary condition" fixed during a cardiac surgery.

Fixing a-fib during cardiac surgeries does not add any more risk to the surgery, noted study senior author Dr. Robert Hawkins , a cardiac surgeon at the UM Health Frankel Cardiovascular Center.

The focus on a-fib is important, the Michigan team added, because the condition is even more dangerous for women than men.

In a second study, the same team looked at nearly 400 people who received mitral valve surgeries between 2014 and 2023. All of the patients were also seen to have moderate-to-severe leaking, or regurgitation, from their tricuspid valve at the time of their surgery.

While about three-quarters of the male patients got their tricuspid valve repaired during the mitral valve surgery, that was true for just 57% of the female patients.

That meant that the women who did not get their tricuspid valves repaired "were more likely to have severe tricuspid regurgitation or to require a valve-related re-operation up to four years later," according to the UM news release.

"This under-treatment occurred despite the fact that additional tricuspid repair is a class I recommendation during left-sided valve surgery," said senior study author Dr. Steven Bolling , a professor of cardiac surgery at the University of Michigan's Medical School. "We must advance the equitable use of guideline-recommended treatment for this procedure."

Why the gender disparities?

According to researchers, surgeons may assume that women face more risks than men if a second procedure is added in during a heart surgery.

But that's just not true: In this study, female patients actually had better outcomes in terms of death risk compared to men.

"Cardiac surgery has pioneered the measurement and delivery of high-quality care," Wagner said. "I think the next step is ensuring that such care is equitable. Our work highlights an opportunity to improve care for women undergoing heart surgery and maximize the benefit patients receive when undergoing these high-risk surgeries."

The studies were published recently in The Journal of Thoracic and Cardiovascular Surgery .

More information

Find out more about atrial fibrillation at the American Heart Association.

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