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Propensity Matched Outcomes of Minimally Invasive Mitral Surgery: Does a Heart-Team Approach Eliminate Female Gender as an Independent Risk Factor?

Background: There is increasing evidence that female gender is an independent risk factor for cardiac surgery. Minimally invasive mitral surgery (MIV) has proven to have excellent long-term results, but little is known about gender-dependent outcomes. The aim of our study was to analyze our heart te...

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Autores principales: Passos, Laina, Lavanchy, Isabel, Aymard, Thierry, Morjan, Mohammed, Kapos, Ioannis, Corti, Roberto, Gruenenfelder, Juerg, Biaggi, Patric, Reser, Diana
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10305141/
https://www.ncbi.nlm.nih.gov/pubmed/37373938
http://dx.doi.org/10.3390/jpm13060949
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author Passos, Laina
Lavanchy, Isabel
Aymard, Thierry
Morjan, Mohammed
Kapos, Ioannis
Corti, Roberto
Gruenenfelder, Juerg
Biaggi, Patric
Reser, Diana
author_facet Passos, Laina
Lavanchy, Isabel
Aymard, Thierry
Morjan, Mohammed
Kapos, Ioannis
Corti, Roberto
Gruenenfelder, Juerg
Biaggi, Patric
Reser, Diana
author_sort Passos, Laina
collection PubMed
description Background: There is increasing evidence that female gender is an independent risk factor for cardiac surgery. Minimally invasive mitral surgery (MIV) has proven to have excellent long-term results, but little is known about gender-dependent outcomes. The aim of our study was to analyze our heart team's decision-based MIV-specialized cohort. Methods: In-hospital and follow-up data were retrospectively collected. The cohort was divided into gender groups and propensity-matched groups. Results: Between 22 July 2013 and 31 December 2022, 302 consecutive patients underwent MIV. Before matching, the total cohort showed that women were older, had a higher EuroSCORE II, were more symptomatic, and had more complex valve pathology and tricuspid regurgitation resulting in more valve replacements and tricuspid repairs. Intensive and hospital stays were longer. In-hospital deaths (n = 3, all women) were comparable, with more atrial fibrillation in women. The median follow-up time was 3.44 (0.008–8.9) years. The ejection fraction, NYHA, and recurrent regurgitation were low and comparable and atrial fibrillation more frequent in women. The calculated 5-year survival and freedom from re-intervention were comparable (p = 0.9 and p = 0.2). Propensity matching compared 101 well-balanced pairs; women still had fewer resections and more atrial fibrillation. During the follow-up, women had a better ejection fraction. The calculated 5-year survival and freedom from re-intervention were comparable (p = 0.3 and p = 0.3). Conclusions: Despite women being older and sicker, with more complex valve pathology and subsequent replacement, early and mid-term mortality and the need for reoperation were low and comparable before and after propensity matching, which might be the result of the MIV setting combined with our patient-tailored decision-making. We believe that a multidisciplinary heart team approach is crucial to optimize patient outcomes in MIV, and it might also reduce the widely reported increased surgical risk in female patients. Further studies are needed to prove our findings.
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spelling pubmed-103051412023-06-29 Propensity Matched Outcomes of Minimally Invasive Mitral Surgery: Does a Heart-Team Approach Eliminate Female Gender as an Independent Risk Factor? Passos, Laina Lavanchy, Isabel Aymard, Thierry Morjan, Mohammed Kapos, Ioannis Corti, Roberto Gruenenfelder, Juerg Biaggi, Patric Reser, Diana J Pers Med Article Background: There is increasing evidence that female gender is an independent risk factor for cardiac surgery. Minimally invasive mitral surgery (MIV) has proven to have excellent long-term results, but little is known about gender-dependent outcomes. The aim of our study was to analyze our heart team's decision-based MIV-specialized cohort. Methods: In-hospital and follow-up data were retrospectively collected. The cohort was divided into gender groups and propensity-matched groups. Results: Between 22 July 2013 and 31 December 2022, 302 consecutive patients underwent MIV. Before matching, the total cohort showed that women were older, had a higher EuroSCORE II, were more symptomatic, and had more complex valve pathology and tricuspid regurgitation resulting in more valve replacements and tricuspid repairs. Intensive and hospital stays were longer. In-hospital deaths (n = 3, all women) were comparable, with more atrial fibrillation in women. The median follow-up time was 3.44 (0.008–8.9) years. The ejection fraction, NYHA, and recurrent regurgitation were low and comparable and atrial fibrillation more frequent in women. The calculated 5-year survival and freedom from re-intervention were comparable (p = 0.9 and p = 0.2). Propensity matching compared 101 well-balanced pairs; women still had fewer resections and more atrial fibrillation. During the follow-up, women had a better ejection fraction. The calculated 5-year survival and freedom from re-intervention were comparable (p = 0.3 and p = 0.3). Conclusions: Despite women being older and sicker, with more complex valve pathology and subsequent replacement, early and mid-term mortality and the need for reoperation were low and comparable before and after propensity matching, which might be the result of the MIV setting combined with our patient-tailored decision-making. We believe that a multidisciplinary heart team approach is crucial to optimize patient outcomes in MIV, and it might also reduce the widely reported increased surgical risk in female patients. Further studies are needed to prove our findings. MDPI 2023-06-03 /pmc/articles/PMC10305141/ /pubmed/37373938 http://dx.doi.org/10.3390/jpm13060949 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Passos, Laina
Lavanchy, Isabel
Aymard, Thierry
Morjan, Mohammed
Kapos, Ioannis
Corti, Roberto
Gruenenfelder, Juerg
Biaggi, Patric
Reser, Diana
Propensity Matched Outcomes of Minimally Invasive Mitral Surgery: Does a Heart-Team Approach Eliminate Female Gender as an Independent Risk Factor?
title Propensity Matched Outcomes of Minimally Invasive Mitral Surgery: Does a Heart-Team Approach Eliminate Female Gender as an Independent Risk Factor?
title_full Propensity Matched Outcomes of Minimally Invasive Mitral Surgery: Does a Heart-Team Approach Eliminate Female Gender as an Independent Risk Factor?
title_fullStr Propensity Matched Outcomes of Minimally Invasive Mitral Surgery: Does a Heart-Team Approach Eliminate Female Gender as an Independent Risk Factor?
title_full_unstemmed Propensity Matched Outcomes of Minimally Invasive Mitral Surgery: Does a Heart-Team Approach Eliminate Female Gender as an Independent Risk Factor?
title_short Propensity Matched Outcomes of Minimally Invasive Mitral Surgery: Does a Heart-Team Approach Eliminate Female Gender as an Independent Risk Factor?
title_sort propensity matched outcomes of minimally invasive mitral surgery: does a heart-team approach eliminate female gender as an independent risk factor?
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10305141/
https://www.ncbi.nlm.nih.gov/pubmed/37373938
http://dx.doi.org/10.3390/jpm13060949
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