Sex-related differences in minimally invasive mitral valve surgery: a review of the evidence

Mitral valve disease (MVD) remains a prevalent cardiac condition and a leading cause of morbidity and mortality globally. Sex-based disparities have been observed in the MVD in terms of clinical presentation, surgical management, and postoperative outcomes. Thereby, women often face delayed referral, more complex valvular pathology, and worse postoperative prognosis. Minimally invasive mitral valve surgery (MIMVS) has gained widespread acceptance as an alternative to traditional median sternotomy in the surgical management of MVD, offering advantages such as reduced surgical trauma, quicker recovery, and improved cosmetic results. Despite the promising results of minimally invasive surgical techniques, compared to conventional sternotomy, studies investigating the correlation between different surgical approaches and female sex are lacking. In this narrative review, we summarize the current evidence regarding sex-related differences in the management and treatment of MVD, with particular attention to MIMVS using the Port-Access system. We emphasize the importance of incorporating sex-specific considerations into both surgical planning and broader clinical decision-making.