Lancashire Cardiac Centre, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK.
Norfolk and Norwich University Hospital, University of East Anglia, Norwich, UK.
Eur J Cardiothorac Surg. 2022 Oct 4;62(5). doi: 10.1093/ejcts/ezac273.
Multiple studies have suggested that women have worse outcomes than men following mitral valve (MV) surgery-most of those studies reported on conventional sternotomy (CS) MV surgery. Therefore, we aimed to explore whether or not the minimally invasive mitral valve surgery (MIMVS) approach might mitigate a worse survival in women following MV surgery.
We identified patients with isolated primary MV 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 had 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.
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 group 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.
Women present to the surgical team at an older age. They appear less likely to be considered for a MIMVS approach than men. Neither sex nor surgical approach was associated with worse survival in a matched sample.
多项研究表明，女性在接受二尖瓣（MV）手术后的预后比男性差-这些研究中的大多数报告了传统胸骨切开术（CS）MV 手术。因此，我们旨在探讨微创二尖瓣手术（MIMVS）是否可能减轻女性 MV 手术后的生存状况恶化。
我们确定了 2007 年至 2019 年间接受单纯 MV 手术（伴或不伴三尖瓣修复术）的患者。患者按照 MIMVS 和 CS 手术方法进行倾向评分匹配。性别排除在匹配过程之外，以辨别女性患者接受微创手术的可能性是否与男性不同。在匹配队列中拟合 Cox 比例风险模型，并使用倾向评分调整基线特征的不平衡。
在 956 例患者（MIMVS 417 例，CS 539 例；女性 424 例）中，共有 342 对（684 例；女性 296 例）患者在 MIMVS 和 CS 组之间具有良好的术前临床特征平衡。CS 组女性/男性比例为 47/53%，MIMVS 组为 39/61%，P=0.054。在两个匹配组中，女性都比男性年长。调整倾向评分的 Cox 模型显示，性别、手术类型或两者之间均无生存差异。
女性就诊时年龄较大。与男性相比，她们似乎不太可能被考虑采用 MIMVS 方法。在匹配样本中，性别和手术方式均与较差的生存率无关。
