The Role of Minimally Invasive Surgery in Mitral Valve Repair: Through the Female Gaze

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.