Key result
Female patients with mitral regurgitation face higher postoperative mortality and later presentation than males.
Why the study?
Less is known about sex-related outcomes in minimally invasive cardiac surgery, particularly in minimally invasive mitral valve repair.
Highlights the critical need to update clinical guidelines to account for sex-specific echocardiographic thresholds and to conduct dedicated research into female outcomes in minimally invasive mitral valve repair.
Sex-specific referral delays may warrant earlier screening in women with mitral regurgitation; leaves open whether minimally invasive repair can reduce excess female mortality.
Purpose of review: Numerous studies have investigated sex-specific differences in mitral regurgitation (MR) and mitral valve (MV) surgery. However, less is known about the possibility of sex-related outcomes in minimally invasive cardiac surgery, particularly in the case of minimally invasive MV repair. This review seeks to highlight existing evidence and identify gaps in the literature. Findings: Female patients with MR tend to present later, more symptomatically, and more comorbidly. This sex bias extends to pre-operative investigation, with females underrepresented in multidisciplinary evaluation and having longer intervals to surgery, often only receiving investigations as inpatients, and suffering from excess post-operative mortality compared to male patients. Very few studies directly investigate how these factors are related to female patients who undergo minimally invasive MV surgery, and fewer still interrogate sex-specific outcomes in minimally invasive MV repair. Summary: As cardiac surgery continues to evolve, it is of utmost importance to fully characterise the importance of sex as a factor in patient care for MR, and further research is necessary to reconcile its role in the advancement of minimally invasive MV surgery.
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Ho et al. (2025) conducted a review in Mitral regurgitation. Minimally invasive mitral valve repair vs. Median sternotomy was evaluated. Female patients with mitral regurgitation present later, have more comorbidities, and suffer higher postoperative mortality compared to males, highlighting a lack of sex-specific data in minimally invasive mitral valve repair.
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