The Silent Cost of Gender in Mitral Valve Surgery: A Propensity-Score Matched Analysis 

In this propensity score matched analysis of 1,531 patients undergoing mitral valve surgery, women presented at an older age, with more advanced symptoms and more complex valve pathology than men. Female patients more frequently exhibited Carpentier type IIIA disease, annular calcification, and concomitant tricuspid involvement, resulting in lower rates of mitral valve repair and minimally invasive surgery. Women experienced higher mortality rates at 30 days and five years. However, after adjusting for valve morphology, calcification, and surgical strategy, sex was no longer an independent predictor of repair rates or long-term survival. These findings indicate that adverse outcomes in women are primarily driven by delayed referrals and more complex disease rather than sex itself, highlighting the need for earlier recognition and intervention.