Gender-Tailored Heart Team Decision Making Equalizes Outcomes for Female Patients after Aortic Valve Replacement through Right Anterior Small Thoracotomy (RAST).

IF 2.4 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiovascular Development and Disease Pub Date : 2024-10-16 DOI:10.3390/jcdd11100329

Isabel Lavanchy, Laina Passos, Thierry Aymard, Jürg Grünenfelder, Maximilian Y Emmert, Roberto Corti, Oliver Gaemperli, Patric Biaggi, Diana Reser

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Abstract

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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心脏团队根据性别做出决策，使通过右前小胸廓切开术（RAST）进行主动脉瓣置换术的女性患者获得同等疗效。

背景：通过右前胸廓切开术（RAST）进行主动脉瓣置换术（AVR）后，人们对与性别相关的预后知之甚少。我们的研究旨在分析我们队列的中期预后：本研究是对 338 名患者（2013-2022 年）的回顾性分析。亚组分析包括≤60岁和大于60岁年龄组的性别比较：女性年龄更大（69.27 ± 7.98 vs. 64.15 ± 11.47，p < 0.001），Euroscore II更高（1.25 ± 0.73 vs. 0.94 ± 0.45，p < 0.001）。分流和交叉钳夹时间更短（109.36 ± 30.8 vs. 117.65 ± 33.1 分钟，p = 0.01；68.26 ± 21.5 vs. 74.36 ± 23.3 分钟，p = 0.01），而重症监护室、住院时间和心房颤动则更高（2.48 ± 8.2 vs. 1.35 ± 1.4 天，p = 0.005；11 ± 7.8 vs. 9.48 ± 2.3 天，p = 0.002；6.7% vs. 4.4%，p = 0.024）。死亡率为 0.9%，中风为 0.6%。年龄亚组分析显示，女性年龄更大（p = 0.025），在重症监护室和医院的住院时间更长（p < 0.001，p = 0.007）。在对315名患者（94.3%）的中期随访（4.52 ± 2.67年）中，性别和年龄组在存活率、MACCE和再干预方面没有显著差异：结论：尽管女性患者年龄更大、Euroscore II评分更高、重症监护室和住院时间更长，但死亡率、MACCE和再次手术率都很低，而且在性别和年龄组中具有可比性。我们相信，我们为患者量身定制的心脏团队决策与 RAST 相结合，可转化为针对不同性别的医疗，从而使广泛报道的女性患者在心脏手术后的不良结果趋于一致。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Cardiovascular Development and Disease CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

2.60

自引率

12.50%

发文量

381