Valvular Heart Diseases in Women: Surgical Outcomes and Gender Differences
DOI:
https://doi.org/10.51253/pafmj.v76iSUPPL-4.14154Keywords:
Aortic Valve, Degenerative, Heart Valve Diseases, Mitral Valve, Treatment OutcomeAbstract
Objective: To describe the pattern of Valvular Heart Disease (VHD) and evaluate gender-based differences in surgical outcomes among patients undergoing Valvular heart surgery at a tertiary cardiac care center.
Study Design: Quasi Experimental study.
Place and Duration of Study: Cardiac Surgery Department, Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi Pakistan, from Jan 2023 to Dec 2025.
Methodology: Data from 965 patients aged >18 years, of both genders, were retrospectively collected using consecutive sampling. The cohort included individuals who underwent elective or emergency valvular heart surgeries either single or multiple valve repair or replacement, with or without concomitant CABG, performed through conventional or minimally invasive approaches. Those patients whose data were incomplete or missing were not included in the study. Patients were classified by gender for the comparisons in baseline demographics, operative variables, and early postoperative outcomes.
Results: Out of the 965 patients, 387(40.1%) were female and 578(59.9%) were male. Males underwent more aortic valve replacements (77.16% vs. 22.8%, p<0.001). However, mitral valve replacements were performed more often on females (61.6% vs. 38.93%, p<0.001). Males had more complex combined procedures, contributing to their longer bypass and cross-clamp times (174 vs. 157 minutes; 128 vs. 112 minutes; p<0.001). Early postoperative mortality was slightly higher in females (3.6%) than in males (2.8%) but difference was insignificant (p>0.05).
Conclusion: Gender-based variations were evident in procedural profiles and perioperative characteristics in VHD patients. Recognizing these differences may help optimize preoperative evaluation and tailor surgical strategies to improve overall outcomes.
Downloads
References
1. Santangelo G, Bursi F, Faggiano A, Moscardelli S, Simeoli PS, Guazzi M, et al. The global burden of valvular heart disease: from clinical epidemiology to management. J Clin Med 2023; 12(6): 2178. https://doi.org/10.3390/jcm12062178
2. Koschutnik M, Kammerlander A, Hengstenberg C, Mascherbauer J, C C. Gender-specific differences in valvular heart disease. Wien Klin Wochenschr 2020; 132(3): 61–68.
https://doi.org/10.1007/s00508-019-01603-x
3. Sitges M, Borregaard B, De Paulis R, Nolan P, Woan W, Pearce K, et al. Creating a better journey of care for patients with heart valve disease. Eur Heart J Open 2021; 1(3): oeab034.
https://doi.org/10.1093/ehjopen/oeab034
4. Waleed M, Malik WM, Jamal K, Khan AH, Shah SS, Tariq M. Gender disparities in postoperative outcomes after mechanical heart valve replacement surgery: an investigative analysis. J Bahria Univ Med Dent Coll 2025; 15(2): 127–133.
https://doi.org/10.51985/JBUMDC2025506
5. Coffey S, Roberts-Thomson R, Brown A, Carapetis J, Chen M, Enriquez-Sarano M, et al. Global epidemiology of valvular heart disease. Nat Rev Cardiol 2021; 18(12): 853–864.
https://doi.org/10.1038/s41569-021-00570-z
6. DesJardin JT, Chikwe J, Hahn RT, Hung JW, Delling FN. Sex differences and similarities in valvular heart disease. Circ Res 2022; 130(4): 455–473.
https://doi.org/10.1161/CIRCRESAHA.121.319914
7. Bhatti S, Rehman S, Fayyaz S, Gurmani S, Karim M, Saghir T, et al. Burden of cardiovascular disease in women: data from Pakistan's largest cardiac hospital network. npj Womens Health 2025; 3(1): 38. https://doi.org/10.1038/s44294-025-00084-w
8. Bhatti S, Rehman S, Iqbal Z, Usman M, Hakeem A. Multidisciplinary innovations in managing complex rheumatic valve disease in low- and middle-income countries: insights from the NICVD Heart Valve Registry in Pakistan. JACC 2024; 29(20): 102621.
https://doi.org/10.1016/j.jaccas.2024.102621
9. Youssef G. Valvular heart diseases in women. Egypt Heart J. 2021; 73(1): 58. https://doi.org/10.1186/s43044-021-00184-3
10. Samiei N, Hakimi MR, Mirmesdagh Y, Peighambari MM, Alizadeh-Ghavidel A, Hosseini S. Surgical outcomes of heart valves replacement: a study of tertiary specialized cardiac center. ARYA Atheroscler 2014; 10(5): 233.
11. Bechtel AJ, Huffmyer JL. Gender differences in postoperative outcomes after cardiac surgery. Anesthesiol Clin 2020; 38(2): 403–415. https://doi.org/10.1016/j.anclin.2020.01.007
12. Moscarelli M, Lorusso R, Angelini GD, Di Bari N, Paparella D, Fattouch K, et al. Sex-specific differences and postoperative outcomes of minimally invasive and sternotomy valve surgery. Eur J Cardiothorac Surg 2022; 61(3): 695–702.
https://doi.org/10.1093/ejcts/ezab369
13. Ilonze O, Free K, Shinnerl A, Lewsey S, Breathett K. Racial, ethnic, and gender disparities in valvular heart failure management. Heart Fail Clin 2023; 19(3): 379–390.
https://doi.org/10.1016/j.hfc.2023.02.009
14. Dixon LK, Dimagli A, Di Tommaso E, Sinha S, Fudulu DP, Sandhu M, et al. Females have an increased risk of short-term mortality after cardiac surgery compared to males: insights from a national database. J Card Surg 2022; 37(11): 3507–3519.
https://doi.org/10.1111/jocs.16928
15. El Sherbini AH, Servito M, Zidan A, Elsherif S, Ko G, Elgendy IY, et al. Sex differences in the outcomes after transcatheter aortic valve replacement with newer generation devices: a meta-analysis. Catheter Cardiovasc Interv 2024; 103(5): 808–814.
https://doi.org/10.1002/ccd.30985
16. Saha S, Meerfeld S, Horke KM, Steinmauer M, Ali A, Juchem G, et al. Gender-based analysis of patients undergoing mitral valve surgery. J Clin Med 2025; 14(19): 7072.
https://doi.org/10.3390/jcm14197072
17. Al-Zubaidi FI, Pufulete M, Salmasi MY, Angelini GD, Vohra HA. Sex-based differences in early outcomes following mitral valve surgery for degenerative disease. Heart Surg Forum 2023; 26(5): 566–576. https://doi.org/10.59958/hsf.6741
18. Perazzo Á, Mariani S, Montenegro GL, Conci L, Sepúlveda DP, Steffen SP et al. Cardiopulmonary Bypass and Cross-Clamping Times in Aortic Valve Replacement Surgery by Ministernotomy with Sutureless Prosthesis Implantation Compared to Conventional Prosthesis: A Cross-Sectional Study. Braz. J. Cardiovasc. Surg 2025; 40(2): e20240290.
https://doi.org/10.21470/1678-9741-2024-0290
19. Wiens EJ, Kawa K, Kass M, Shah AH. Impact of biological sex on valvular heart disease, interventions, and outcomes. Can J Physiol Pharmacol 2024; 102(10): 585–593.
https://doi.org/10.1139/cjpp-2023-0390
20. Hahn RT, Clavel MA, Mascherbauer J, Mick SL, Asgar AW, Douglas PS. Sex-related factors in valvular heart disease: JACC focus seminar 5/7. J Am Coll Cardiol 2022; 79(15): 1506–1518.
https://doi.org/10.1016/j.jacc.2021.08.081
21. Lodo V, Italiano EG, Weltert L, Zingarelli E, Perrucci C, Pietropaolo C, et al. The influence of gender on outcomes following transcatheter aortic valve implantation. Front Cardiovasc Med 2024; 11: 1417-1430.
https://doi.org/10.3389/fcvm.2024.1417430
22. Matkovic M, Zivkovic I, Micovic S, Bilbija I, Milacic P, Aleksic N, et al. Sex-related differences in patient characteristics, practice patterns and outcomes after bioprosthetic and mechanical aortic valve replacement. Interdiscip Cardiovasc Thorac Surg 2025; 40(5): ivaf110. https://doi.org/10.1093/icvts/ivaf110
Downloads
Published
License
Copyright (c) 2026 Farah Sobia, Vaqar Illahi Paracha, Tahseen ., Asad Ullah, Shabnum Ara
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
