Effect of sex and surgical incision on survival after isolated primary mitral valve operations

Maciej Dębski, Rebecca Taylor, Amr Abdelrahman, Karolina Dębska, Omar Assaf, Syed Qadri, Kenneth Y-K Wong, Vassilios Vassiliou, Joseph Zacharias

Research output: Contribution to journalArticlepeer-review


Objectives: Multiple studies have suggested that women have worse outcomes than men following mitral valve surgery—most of those studies reported on conventional sternotomy mitral valve surgery (CS). Therefore, we aimed to explore whether or not the minimally invasive mitral valve surgery (MIMVS) approach might mitigate a worse survival in women following CS.

Methods: We identified patients with isolated primary mitral valve operations with or without tricuspid valve repair performed between 2007 and 2019. Patients were propensity score-matched across the MIMVS and CS surgical approaches. Sex was excluded from the matching process to discern whether female patients have a different likelihood of receiving minimally invasive surgery than males. A Cox proportional hazards model was fitted in the matched cohort and adjusted for the imbalance in baseline characteristics using the propensity score.

Results: Of 956 patients (417 MIMVS, 539 CS; 424 females), the matched set comprised 342 pairs (684 patients; 296 females) of patients who were well balanced across MIMVS and CS groups with regard to preoperative clinical characteristics. We observed a 47/53% female/male ratio in the CS and a 39/61% in the MIMVS group, p = 0.054. In both matched groups, women were older than males. A Cox model adjusted for propensity scores showed no survival difference with sex, surgical type, or interaction.

Conclusions: Women present to the surgical team at an older age. They appear to be less likely to be considered for a MIMVS approach than men. Neither sex nor surgical approach was associated with survival in a matched sample.
Original languageEnglish
JournalEuropean Journal of Cardio-Thoracic Surgery
Early online date26 Apr 2022
Publication statusE-pub ahead of print - 26 Apr 2022

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