Advances in Women's Valvular Health

On behalf of the editorial board, I am pleased and proud to introduce the fifth issue in the life of the Journal of the Heart Valve Society (JHVS), which is actually the first issue of Volume 3 published in 2026. This issue primarily focuses on Advances in Women's Valvular Health and constitutes an important extension of the previous issue of the journal that was focusing on the disparities and inequities in the management of heart valve disease (HVD). Indeed, women living with HVD are often underserved and undertreated, which leads to worse outcomes compared to men.^1–3 Women are also underrepresented in clinical trials and in HVD research studies in general, therefore leading to a lack of data to guide the personalized management of HVD in women. The current issue of the JHVS, which presents 2 original articles, 2 review articles, and 1 technical note, contributes to substantially advances the knowledge of the pathophysiology and management of HVD in women.

In an original research article, Michel Pompeu Sà from the Cleveland Clinic Florida, USA, Gabriel Neves, Jose L. Navia, and other colleagues from several academic centres in Brazil present a meta-analysis of 5 studies/3303 patients comparing the outcomes of supraannular valve (SAV) versus intra-annular valve (IAV) self-expanding transcatheter heart valves in patients with a small annulus, defined as an aortic annulus area <430 mm². One of the anatomical hallmarks of women is the small aortic annulus, which represents a challenge for the cardiac surgeon or interventionalist performing an aortic valve replacement (AVR) procedure. It is thus not surprising that 87% of the population included in this meta-analysis were women.^4,5 Transcatheter AVR (TAVR) appears to outperform surgical AVR in women/small annulus. However, it remains uncertain whether differences in hemodynamic and clinical outcomes exist between the different TAVR platforms: that is, between self-expanding versus balloon expandable valves and then between SAVs versus IAVs. This meta-analysis reveals that in patients with a small annulus, and so in women, SAVs are associated with a lower risk of prosthesis-patient mismatch and better 5-year survival compared to IAV.

This original article by Pompeu Sà et al is accompanied by an insightful editorial by Sraman Chatterjee and Rutger-Jan Nuis from Erasmus Medical Center in the Netherlands, which states that while current data seem to favor the superior hemodynamics of SAVs in patients with small aortic annuli, the balance between procedural safety, device performance, long-term durability, and future reintervention needs remains critical. This editorial highlights the importance of personalized approaches and further research to optimize outcomes for all patients undergoing TAVR.

Lionel Tastet from the Institut Universitaire de Cardiologie et de Pneumologie de Québec, Canada, and Francesca Delling and other co-authors from the University of California in San Francisco, USA, present the results of an original study that examined the association between menopausal age, arrhythmic risk, and cardiovascular outcomes in 299 women with mitral valve prolapse (MVP). The arrhythmic MVP syndrome has received a lot of attention in the past decade and is more prevalent in women. The authors found that premature or early menopause in women with MVP was associated with an increased risk of arrhythmic events and adverse cardiovascular outcomes.

This article was accompanied by an excellent editorial by Amélie Paquin from the Institut Universitaire de Cardiologie et de Pneumologie de Québec, who considered that this study by Tastet et al represents a major step toward closing persistent knowledge gaps in women's cardiovascular health. These novel findings suggest that menopausal age may serve as an additional risk stratification factor in women with MVP.

In this issue of the journal, we feature a state-of-the-art review article by Augustin Coisne from Lille University Hospital in France, Juan Granada from Cardiovascular Research Foundation, New York, USA, and several key opinion leaders in the field from different universities in France, Germany, and Switzerland. This article provides a comprehensive overview of the pathophysiology, outcomes, and imaging evaluation of mitral annulus calcification (MAC), which is a challenging entity, more prevalent in elderly people and in women. The authors underline that, despite advancements in imaging and therapeutic strategies, MAC remains a significant challenge in cardiovascular medicine, necessitating further research into its pathophysiology, optimal management strategies, and long-term outcomes.

Bana Samman, Maral Ouzounian, and colleagues from Peter Munk Cardiac Centre, University Health Network, Toronto, Canada, present an excellent review article on the contemporary perspectives and lifetime considerations in women with aortic stenosis. One of the key messages of this article is that implementing a personalised, lifetime approach to aortic stenosis in women will ultimately help bridge the gap in their care and improve long-term outcomes. This article provides some important incremental information besides the excellent review article previously published in the JHVS by Kathia Abdoun, Marie-Annick Clavel et al, which was focused on HVD in women. ⁶

Finally, Shashwat Shrivastava from Montefiore Medical Center, New York, USA, Sandeep Shrivastava from Medanta Super Specialty Hospital, Indore, Madhya Pradesh, India, and colleagues present a very interesting clinical case of complete endoatriectomy of the coconut left atrium with mitral valve replacement and tricuspid repair in a 48-year-old woman. This is the first report of successful mitral valve replacement and tricuspid repair in a patient with a coconut left atrium with dense calcification of the entire left atrium and interatrial septum that was complicated by a soft thrombus.

I am convinced that you will enjoy and learn a lot by reading this spectacular issue that we are publishing today on such an important and timely topic: that is, the valvular health of women. At the JHVS, we are committed to publishing articles that advance and disseminate the knowledge on the pathophysiology, diagnosis, prevention, and treatment of HVD, especially in underserved/undertreated/underrepresented populations, which include women, elderly people, people with low socioeconomic status or living in low-middle income countries, and first-nation people. So, in the future, we will always welcome submissions of original research, review, or viewpoint articles on this topic that is close to our heart.