Sex-based differences in mitral and tricuspid valve disease in the era of transcatheter therapies: a contemporary review

Sex-based differences in cardiovascular disease are well recognized; however, their implications in valvular heart disease (VHD), particularly mitral and tricuspid valve disorders, remain incompletely understood. As transcatheter therapies for structural heart disease rapidly expand, understanding how biological sex influences disease presentation, diagnostic evaluation, and procedural outcomes has become increasingly important. This review summarizes current evidence on sex-related differences in the epidemiology, pathophysiology, imaging assessment, and management of mitral and tricuspid valve disease in the era of transcatheter interventions. Women have a higher prevalence of mitral and tricuspid valve disease and often present with smaller cardiac chamber dimensions, distinct valvular morphology, and different patterns of ventricular remodeling compared with men. These differences may influence disease severity assessment, timing of intervention, and procedural outcomes. Multimodality imaging-including echocardiography, cardiac magnetic resonance, and cardiac computed tomography-plays a key role in identifying anatomical and functional variations that may contribute to these disparities. Despite increasing use of transcatheter mitral and tricuspid interventions, women remain underrepresented in clinical trials and registries, limiting the development of sex-specific treatment strategies. Available data suggest comparable procedural success across sexes, although disparities in complications, symptom burden, and referral patterns persist. Addressing these gaps through equitable trial enrollment, sex-specific imaging thresholds, and mechanistic research will be essential to advancing personalized and equitable care for patients with valvular heart disease.