Key result
Minimally invasive right thoracotomy AVR achieves comparable 5-year survival in women despite higher baseline risk.
Why the study?
Little is known about gender-dependent outcomes after aortic valve replacement through right anterior thoracotomy.
Does gender-tailored heart team decision making combined with RAST equalize mid-term outcomes for female patients compared to male patients after aortic valve replacement?
Cohort (n=338)
No
Does gender-tailored heart team decision making combined with RAST equalize mid-term outcomes for female patients compared to male patients after aortic valve replacement?
Patient-tailored heart team decision making combined with a minimally invasive RAST approach for aortic valve replacement achieves excellent and equal mid-term outcomes for women compared to men, overcoming the historically higher surgical risk in female patients.
Answers are grounded in this paper and cite their sources.
Comparable survival with RAST despite higher female risk; hypothesis-generating for gender-tailored approaches, needs prospective confirmation before practice change.
Background: Little is known about gender-dependent outcomes after aortic valve replacement (AVR) through right anterior thoracotomy (RAST). The aim of our study was to analyze the mid-term outcomes of our cohort. Methods: This study is a retrospective analysis of 338 patients (2013–2022). Subgroup analysis included a gender-dependent comparison of age groups ≤60 and >60 years. Results: Women were older (69.27 ± 7.98 vs. 64.15 ± 11.47, p < 0.001) with higher Euroscore II (1.25 ± 0.73 vs. 0.94 ± 0.45, p < 0.001). Bypass and cross-clamp time were shorter (109.36 ± 30.8 vs. 117.65 ± 33.1 minutes, p = 0.01; 68.26 ± 21.5 vs. 74.36 ± 23.3 minutes, p = 0.01), while ICU, hospital stay and atrial fibrillation were higher (2.48 ± 8.2 vs. 1.35 ± 1.4 days, p = 0.005; 11 ± 7.8 vs. 9.48 ± 2.3 days, p = 0.002; 6.7% vs. 4.4%, p = 0.024). Mortality was 0.9%, while stroke was 0.6%. Age subgroup analysis showed that women were older (p = 0.025) with longer ICU and hospital stays (p < 0.001, p = 0.007). On mid-term follow-up (4.52 ± 2.67 years) of 315 patients (94.3%), there was no significant difference in survival, MACCE and re-intervention comparing gender and age groups. Conclusions: Despite older age, higher Euroscore II, longer ICU and hospital stay in women, mortality, MACCE and reoperation were low and comparable in gender and age groups. We believe that our patient-tailored heart team decision making combined with RAST translates into gender-tailored medicine, which equalizes the widely reported negative outcomes of female patients after cardiac surgery.
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Lavanchy et al. (2024) conducted a cohort in Isolated aortic valve disease (n=338). Female gender vs. Male gender was evaluated on 5-year overall survival (p=0.7). Despite older age and higher surgical risk scores, female patients undergoing aortic valve replacement via right anterior small thoracotomy had comparable 5-year survival (95.2% vs 93.8%, p=0.7) to male patients.
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