FEATURES AND RISK STRATIFICATION IN ENDOSCOPIC MITRAL VALVE SURGERY. DOES GENDER BIAS EXIST?

Background and Aim: Since 10 years, gender bias is source of interest in cardiac surgery: women patients are supposed to have longer cardiological history, later referral to surgery and higher postoperative complications rate. The last frontier of minimally invasive cardiac surgery is the endoscopic approach, that makes surgery more customized. Methods: During the last 2 years 143 patients underwent endoscopic mitral valve surgery: 54 women and 89 men. Surgical access is through the 4th intercostal right space, positioning the camera on the anterior/mid axillary line. Baseline characteristics were similar between the 2 groups; median age in males was 61, in females 64 (p= 0.008). Median EuroSCORE log and II were higher in the female group: 1.86 and 0.67 versus 4.11 and 1.28 (p < 0.001). Results: Mitral valve repair was performed in 134 patients (94% vs mitral valve replacement in 6%). Similar CBP and cross-clamping time were reported (F: 169 and 114 minutes; M: 183 and 121 minutes). 30-day and in-hospital mortality were 0.6 and 2% respectively. No statistically significant difference was reported between the groups in terms of mortality, reoperations for bleeding (p= 0.55), transfusion rate (p= 0.069), respiratory (p=0.78) complications, pacemaker (PM) rate implantation (p=0.378), sepsis (p=0.55), and acute kidney injury (p=1). Postoperative EF were similar, with higher transmitral gradients in women (3.9 vs 2.9 mmHg). Conclusion: Our standardised approach for endoscopic mitral valve surgery is safe, makes the surgical gesture precise and reproducible and levels out the potential differences due to gender bias.