Systematic review and meta-analysis of the impact of sex on outcomes after aortic valve replacement.

AIMS: In recent years, extensive literature has been produced demonstrating inferior outcomes for women when compared with men undergoing heart valve interventions. Herein, we seek to analyze the literature comparing outcomes between men and women undergoing surgical aortic valve replacement (SAVR). METHODS: A systematic literature search of PubMed, MEDLINE, and Embase was conducted for articles comparing differences in outcomes between adult men and women undergoing SAVR. One thousand nine hundred and ninety titles were screened, of which 75 full texts were reviewed, and a total of 19 manuscripts met the inclusion criteria and were included in this review. RESULTS: Pooled estimates of mortality demonstrated that women tended to have lower rates of survival within the first 30 days post-SAVR, although mid-term and long-term mortality did not differ significantly up to 10 years postoperatively. Pooled estimates of postoperative data indicated no difference in the rates of stroke and postoperative bleeding. Rates of aortic valve reoperation and acute kidney injury favored women. CONCLUSION: Despite the inferior outcomes for women post-SAVR that have been reported in recent years, the results of this meta-analysis demonstrate comparable results between the sexes with comparable mid- to long-term mortality in data pooled from the literature. Although mortality favored men in the short term, rates of aortic valve reoperation and acute kidney injury favored women. Future investigation into this field should focus on identifying discrepancies in diagnosis and initial surgical management in order to address any potential factors contributing to discrepant short-term outcomes. GRAPHICAL ABSTRACT: http://links.lww.com/JCM/A651.

Minimally Invasive Approaches to Mitral Valve Surgery: Where Are We Now? A Narrative Review.

Minimally invasive mitral valve surgery (MiMVS) has been increasing in prevalence. This review focuses on the approaches, clinical outcomes, and patient selection for MiMVS. There are 4 minimally invasive approaches to the mitral valve: right mini-thoracotomy (including video-assisted and fully endoscopic), robotic mitral surgery, and transapical beating heart off-pump neochordal repair. Advantages over conventional surgery include less blood loss and transfusion, improved postoperative mobility, shorter length of stay, less postoperative atrial fibrillation, fewer surgical site infections, and improved cosmesis. This range of minimally invasive techniques will continue to evolve, providing options that are tailored for different patient populations.

Impact of sex on long-term outcomes following mitral valve repair.

Introduction: Previous studies have identified inferior outcomes for women undergoing mitral valve (MV) surgery compared to men, although the cause of this discrepancy has not been identified. We look to isolate surgical approach to identify any impact that sex has on outcomes in order to better inform clinical decision making. Materials and methods: In this propensity matched, retrospective, single-center study, outcomes were compared between males and females undergoing a MV repair between 2004 and 2018. The primary outcome was defined as mortality at any point in the follow-up period. Secondary outcomes included stroke, myocardial infarction (MI), repeat revascularization, complications arising from the initial procedure, and postoperative cardiac remodeling. Results: A total of 188 males and 188 females were included after propensity matching. At a median follow up time of 7.6 years, there were 25 deaths in the male group (26.8%) and 23 in the female group (28.2%) (p = 0.771). There were no significant differences in MI, stroke, post-operative pacemaker insertion, or rehospitalization following MV repair. Left ventricular (LV) size for males was reduced from an initial 55.6 ± 7.3 mm to 49.9 ± 7.4 mm (p < 0.001), and for females from an initial 51.5 ± 7 mm to 46.9 ± 7.1 mm (p < 0.001). LV ejection fraction (LVEF) was reduced with a preoperative LVEF for males of 57.7% ± 8.9% and 53.7% ± 9.6% postoperatively (p = 0.002), and LVEF for females of 57.8% ± 9.1% preoperatively and 54.8% ± 9.2% postoperatively (p < 0.001). Left atrial (LA) volume was reduced from an initial 51 ± 22 ml/m2 to 43.7 ± 25.2 ml/m2 (p < 0.001), and 50.9 ± 19.2 ml/m2 to 44.2 ± 19.8 ml/m2 (p < 0.001), for males and females respectively. LA diameter was reduced for males from an initial 49.7 ± 9.7 mm to 47.3 ± 9.4 mm (p = 0.043), and from 48 ± 8.7 mm to 44.3 ± 9.1 mm for females postoperatively (p = 0.017). Conclusions: Current literature demonstrates inferior outcomes for females when compared to males undergoing MV surgery with patients undergoing a variety of surgical approaches. The results of this study suggest that surgical intervention for a subset of patients, those undergoing repair of the MV, is safe and offers similar outcomes for males and females.