Sex-specific differences and postoperative outcomes of minimally invasive and sternotomy valve surgery

• Published in: European Journal of Cardio-Thoracic Surgery Vol. 61; no. 3; pp. 695 - 702
• Main Authors: Moscarelli, Marco, Lorusso, Roberto, Angelini, Gianni D, Di Bari, Nicola, Paparella, Domenico, Fattouch, Khalil, Albertini, Alberto, Nasso, Giuseppe, Fiorentino, Francesca, Speziale, Giuseppe
• Format: Journal Article
• Language: English
• Published: Germany Oxford University Press (OUP) 18.02.2022; Oxford University Press
• Subjects: Aortic Valve; Aortic Valve - surgery; Female; Female sex; GENDER-DIFFERENCES; General Adult Cardiac; Heart Valve Prosthesis Implantation; Heart Valve Prosthesis Implantation - methods; HIGH-RISK PATIENTS; Humans; Length of Stay; Male; Minimally invasive surgery; Minimally Invasive Surgical Procedures; Minimally Invasive Surgical Procedures - adverse effects; Minimally Invasive Surgical Procedures - methods; Postoperative mortality; Postoperative outcomes; Retrospective Studies; Sternotomy; Sternotomy - adverse effects; Sternotomy - methods; SURVIVAL; Treatment Outcome; TRIALS; Postoperative mortality; Minimally invasive surgery; Female sex; Postoperative outcomes
• ISSN: 1010-7940; 1873-734X; 1873-734X
• DOI: 10.1093/ejcts/ezab369

Abstract   OBJECTIVES Female sex is an established risk factor for postoperative complications after heart surgery, but the influence of sex on outcomes after minimally invasive cardiac surgery (MICS) for valvular replacement/repair remains controversial. We examined whether the role of sex as a risk factor varies by surgical approach [MICS vs conventional sternotomy (ST)] and further assessed outcomes among female patients including in-hospital mortality and postoperative complications by surgical approach. METHODS We analysed data from a multicentre registry for patients who underwent isolated aortic valve and mitral surgery with MICS or ST. The primary outcome was in-hospital mortality. Propensity score matching was used to minimize between-group differences. RESULTS Among the 15 155 patients included in the study, 7674 underwent MICS (50.6%). Female sex was equally distributed in the MICS and ST groups (47.3% vs 47.6%, respectively). Risk for surgery was higher in the ST group than in the MICS group {EuroSCORE II: 4.0 [standard deviation (SD): 6.8] vs 3.7 [SD: 6.4]; P = 0.005}, including among female patients only [ST vs MICS 4.6 (SD: 6.9) vs 4.2 (SD: 6.3); P = 0.04]. Mortality did not significantly vary by procedure among women [MICS vs ST, 2.4% vs 2.8%; hazard ratio 1.09, 95% confidence interval 0.71–1.73; P (surgical approach × sex) = 0.51]. The results also did not vary after adjusting for confounders. CONCLUSIONS Female sex was associated with higher mortality in patients undergoing valve surgery, regardless of surgical approach. In female patients, MICS did not provide any benefits over ST in terms of in-hospital deaths or postoperative complications. Subject collection 117, 125. Female sex is a strong, independent risk factor for mortality after cardiac surgery, and it is included in the Society of Thoracic Surgeons [1] and EuroSCORE II risk models [2].