Valvular Heart Disease

Abstract Valvular heart disease is an important cause of morbidity and mortality among women. Aortic stenosis (AS) is the most common valvular disease in the elderly and is associated with poor outcomes. There are significant sex-related differences in the pathophysiological response to severe AS, baseline characteristics, and outcomes after aortic valve replacement (AVR). Although female sex is a predictor of worse outcomes after surgical AVR (SAVR), women appear to have a mortality benefit after transcatheter AVR (TAVR) when compared to men. Data evaluating the sex-related differences among patients with aortic regurgitation (AR) are scarce and there is a lack of sex-specific guidelines for surgical intervention. Sex-related differences have been well described in the etiology, underlying pathology, and hemodynamic response to severe mitral regurgitation (MR). Mitral stenosis (MS) is most commonly secondary to rheumatic heart disease (RHD), although degenerative MS secondary to mitral annular calcification (MAC) is increasingly recognized and more common among women. Women have overall worse long-term outcomes after mitral valve (MV) surgery when compared with men, possibly owing to delayed referral. Tricuspid regurgitation (TR) is more prevalent among women and associated with increased mortality among both sexes. Further research is needed to establish guidelines for the most appropriate timing of tricuspid valve (TV) interventions. Women with left-sided stenotic valvular lesions carry a high risk of maternal and fetal adverse outcomes in the setting of pregnancy. Young women undergoing valvular replacement require special counseling regarding the risks and benefits inherent to each type of valvular prosthesis particularly if a future pregnancy may be desired.