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Background <p>Degenerative mitral regurgitation (DMR) shows sex-specific differences in pathology, time of presentation, and management. Women are referred later, undergo repair less often, and receive minimally invasive surgery less frequently than men.</p> Objective <p>This article aims to review the current evidence on sex-related differences in minimally invasive mitral valve surgery (MIMVS) and to derive practical recommendations.</p> Materials and methods <p>A narrative review of propensity score-matched cohorts, multinational registries (MIDA), and randomized data (CTSN) published in PubMed between 2019 and January 2026 was constructed. Synthesis focused on repair rate, MIMVS proportion, 30-day mortality, and mid- to long-term survival.</p> Results <p>Women undergoing mitral valve surgery are 4–6&#xa0;years older on average, more often in New York Heart Association (NYHA) class&#xa0;III–IV, and present more often with Carpentier type&#xa0;IIIa pathology and annular calcification. Repair rates are consistently lower in women (67% vs.&#xa0;85% in Pölzl, 50% vs.&#xa0;67% in Saha), as is the proportion of MIMVS (49% vs.&#xa0;65%). Adjusted 30-day mortality is increased roughly fourfold in women (hazard ratio 4.07). In experienced centers with structured heart team strategies and early referral, outcomes equalize between sexes.</p> Conclusion <p>The observed disparities are only partly biological; system and operator factors contribute substantially. A&#xa0;standardized treatment pathway with early indication, advanced imaging, and consistent heart team evaluation in dedicated mitral valve centers can reduce sex-related disparities in access to MIMVS.</p>

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Mitralklappenrekonstruktion im Vergleich der Geschlechter

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年7月9日

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  • Katja Buschmann,
  • H. Treede

摘要

Background

Degenerative mitral regurgitation (DMR) shows sex-specific differences in pathology, time of presentation, and management. Women are referred later, undergo repair less often, and receive minimally invasive surgery less frequently than men.

Objective

This article aims to review the current evidence on sex-related differences in minimally invasive mitral valve surgery (MIMVS) and to derive practical recommendations.

Materials and methods

A narrative review of propensity score-matched cohorts, multinational registries (MIDA), and randomized data (CTSN) published in PubMed between 2019 and January 2026 was constructed. Synthesis focused on repair rate, MIMVS proportion, 30-day mortality, and mid- to long-term survival.

Results

Women undergoing mitral valve surgery are 4–6 years older on average, more often in New York Heart Association (NYHA) class III–IV, and present more often with Carpentier type IIIa pathology and annular calcification. Repair rates are consistently lower in women (67% vs. 85% in Pölzl, 50% vs. 67% in Saha), as is the proportion of MIMVS (49% vs. 65%). Adjusted 30-day mortality is increased roughly fourfold in women (hazard ratio 4.07). In experienced centers with structured heart team strategies and early referral, outcomes equalize between sexes.

Conclusion

The observed disparities are only partly biological; system and operator factors contribute substantially. A standardized treatment pathway with early indication, advanced imaging, and consistent heart team evaluation in dedicated mitral valve centers can reduce sex-related disparities in access to MIMVS.