Sex hormone levels have little impact on outcomes of cardiac surgery in fertile women with congenital heart disease: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Kaiyu ^1,2 , FANG Yushen ^1,2 , MA Jianrui ^1,2,3 , YUAN Haiyun ^1,2 ,  ZHUANG Jian ^1,2

1. Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, P. R. China;
2. Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, 510080, P. R. China;
3. Shantou University Medical College, Shantou, 515041, Guangdong, P. R. China;

Corresponding author：

ZHUANG Jian, Email: zhuangjian5413@163.com

Keywords：

Sex hormone; cardiac surgery; congenital heart disease; fertile women

DOI：

10.7507/1007-4848.202310063

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Abstract Full text Figures/Tables Video References Cited by

Objective To examine the influence of hormonal fluctuations on the perioperative outcomes of patients undergoing congenital heart surgery. Methods We conducted a retrospective analysis of clinical data from fertile women diagnosed with congenital heart disease at the Guangdong Provincial People's Hospital, between January 1, 2015, and July 30, 2019. Initially, patients were categorized into groups based on serum progesterone levels: a low progesterone group (n=31) and a high progesterone group (n=153). Furthermore, based on serum estrogen levels, they were divided into a low estrogen group (n=10), a medium estrogen group (n=32), and a high estrogen group (n=118) for comparative analysis. A control group (n=24) consisted of patients who received progesterone injections before their menstrual period. Results We finally included 184 patients. The patients’ average age was 27.6±5.7 years, with 142 (77.17%) presenting with complex congenital heart conditions. There were statistically significant differences in total postoperative standard thoracic drainage volume and postoperative albumin level between the high and low progesterone groups (P<0.05), while other perioperative outcome indicators showed no statistical differences (P>0.05). Among the different serum estrogen level groups, there were statistically significant differences in postoperative blood urea nitrogen levels, total postoperative standard thoracic drainage volume, and hospital stay (P<0.05), while other perioperative outcome indicators showed no statistical differences (P>0.05). Conclusion Considering the overall clinical significance, the physiological changes in sex hormone levels appear to have a negligible effect on the perioperative outcomes of fertile women with congenital heart disease.

Citation： WANG Kaiyu, FANG Yushen, MA Jianrui, YUAN Haiyun, ZHUANG Jian. Sex hormone levels have little impact on outcomes of cardiac surgery in fertile women with congenital heart disease: A retrospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(6): 878-884. doi: 10.7507/1007-4848.202310063 Copy

1.	Qu Y, Liu X, Zhuang J, et al. Incidence of congenital heart disease: The 9-year experience of the guangdong registry of congenital heart disease, China. PloS One, 2016, 11(7): e0159257.
2.	Stout KK, Daniels CJ, Aboulhosn JA, et al. 2018 AHA/ACC guideline for the management of adults with congenital heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol, 2019, 73(12): e81-e192.
3.	Duft K, Schanz M, Pham H, et al. 17β-estradiol-induced interaction of estrogen receptor α and human atrial essential myosin light chain modulates cardiac contractile function. Basic Res Cardiol, 2017, 112(1): 1.
4.	Baggish AL, Weiner RB, Kanayama G, et al. Cardiovascular toxicity of illicit anabolic-androgenic steroid use. Circulation, 2017, 135(21): 1991-2002.
5.	Cutolo M, Straub RH. Sex steroids and autoimmune rheumatic diseases: State of the art. Nat Rev Rheumatol, 2020, 16(11): 628-644.
6.	Vasanthakumar A, Chisanga D, Blume J, et al. Sex-specific adipose tissue imprinting of regulatory T cells. Nature, 2020, 579(7800): 581-585.
7.	Schmid S, Fent K. 17β-estradiol and the glucocorticoid clobetasol propionate affect the blood coagulation cascade in zebrafish. Environ Pollut, 2020, 259: 113808.
8.	Bofill Rodriguez M, Lethaby A, Jordan V. Progestogen-releasing intrauterine systems for heavy menstrual bleeding. Cochrane Database Syst Rev, 2020, 6(6): CD002126.
9.	Zengin K, Tokac M, Duzenli MA, et al. Influence of menstrual cycle on cardiac performance. Maturitas, 2007, 58(1): 70-74.
10.	Visniauskas B, Kilanowski-Doroh I, Ogola BO, et al. Estrogen-mediated mechanisms in hypertension and other cardiovascular diseases. J Human Hypertension, 2023, 37(8): 609-618.
11.	Kisovar A, Becker CM, Granne I, et al. The role of CD8+ T cells in endometriosis: A systematic review. Front Immunol, 2023, 14: 1225639.
12.	Adapen C, Réot L, Nunez N, et al. Local innate markers and vaginal microbiota composition are influenced by hormonal cycle phases. Front Immunol, 2022, 13: 841723.
13.	Chaireti R, Gustafsson KM, Byström B, et al. Endogenous thrombin potential is higher during the luteal phase than during the follicular phase of a normal menstrual cycle. Hum Reprod, 2013, 28(7): 1846-1852.
14.	Goswami N, Brix B, Roessler A, et al. Menstrual phase affects coagulation and hematological parameters during central hypovolemia. J Clin Med, 2020, 9(10): 3118.
15.	Findikcioglu K, Findikcioglu F, Sezgin B, et al. The impact of the menstrual cycle on intra-operative and postoperative bleeding in abdominoplasty patients. J Plast Reconstr Aesthet Surg, 2012, 65(12): e338-e343.
16.	Heckmann M, d'Uscio CH, de Laffolie J, et al. Major cardiac surgery induces an increase in sex steroids in prepubertal children. Steroids, 2014, 81: 57-63.

1. Qu Y, Liu X, Zhuang J, et al. Incidence of congenital heart disease: The 9-year experience of the guangdong registry of congenital heart disease, China. PloS One, 2016, 11(7): e0159257.
2. Stout KK, Daniels CJ, Aboulhosn JA, et al. 2018 AHA/ACC guideline for the management of adults with congenital heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol, 2019, 73(12): e81-e192.
3. Duft K, Schanz M, Pham H, et al. 17β-estradiol-induced interaction of estrogen receptor α and human atrial essential myosin light chain modulates cardiac contractile function. Basic Res Cardiol, 2017, 112(1): 1.
4. Baggish AL, Weiner RB, Kanayama G, et al. Cardiovascular toxicity of illicit anabolic-androgenic steroid use. Circulation, 2017, 135(21): 1991-2002.
5. Cutolo M, Straub RH. Sex steroids and autoimmune rheumatic diseases: State of the art. Nat Rev Rheumatol, 2020, 16(11): 628-644.
6. Vasanthakumar A, Chisanga D, Blume J, et al. Sex-specific adipose tissue imprinting of regulatory T cells. Nature, 2020, 579(7800): 581-585.
7. Schmid S, Fent K. 17β-estradiol and the glucocorticoid clobetasol propionate affect the blood coagulation cascade in zebrafish. Environ Pollut, 2020, 259: 113808.
8. Bofill Rodriguez M, Lethaby A, Jordan V. Progestogen-releasing intrauterine systems for heavy menstrual bleeding. Cochrane Database Syst Rev, 2020, 6(6): CD002126.
9. Zengin K, Tokac M, Duzenli MA, et al. Influence of menstrual cycle on cardiac performance. Maturitas, 2007, 58(1): 70-74.
10. Visniauskas B, Kilanowski-Doroh I, Ogola BO, et al. Estrogen-mediated mechanisms in hypertension and other cardiovascular diseases. J Human Hypertension, 2023, 37(8): 609-618.
11. Kisovar A, Becker CM, Granne I, et al. The role of CD8+ T cells in endometriosis: A systematic review. Front Immunol, 2023, 14: 1225639.
12. Adapen C, Réot L, Nunez N, et al. Local innate markers and vaginal microbiota composition are influenced by hormonal cycle phases. Front Immunol, 2022, 13: 841723.
13. Chaireti R, Gustafsson KM, Byström B, et al. Endogenous thrombin potential is higher during the luteal phase than during the follicular phase of a normal menstrual cycle. Hum Reprod, 2013, 28(7): 1846-1852.
14. Goswami N, Brix B, Roessler A, et al. Menstrual phase affects coagulation and hematological parameters during central hypovolemia. J Clin Med, 2020, 9(10): 3118.
15. Findikcioglu K, Findikcioglu F, Sezgin B, et al. The impact of the menstrual cycle on intra-operative and postoperative bleeding in abdominoplasty patients. J Plast Reconstr Aesthet Surg, 2012, 65(12): e338-e343.
16. Heckmann M, d'Uscio CH, de Laffolie J, et al. Major cardiac surgery induces an increase in sex steroids in prepubertal children. Steroids, 2014, 81: 57-63.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Sex hormone levels have little impact on outcomes of cardiac surgery in fertile women with congenital heart disease: A retrospective cohort study

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