Prof Nicole Karam (Clemenceau Medical Center, Beirut, LB) shares her perspective on the evolving role of sex‑specific considerations in structural and valvular interventions, highlighting the persistent challenge of late referral in women. In clinical practice, this often translates into treating older patients with more advanced disease and greater comorbidity burden. Differences in disease prevalence are also evident, with higher rates of conditions such as tricuspid and atrial mitral regurgitation in women, underscoring the need for earlier recognition and more tailored assessment.

From a procedural standpoint, smaller cardiac structures, valve annuli and vascular access in women continue to influence device selection, procedural strategy and long-term planning. These anatomical factors may impact decisions between surgery and transcatheter approaches, particularly when considering valve sizing and lifetime management. Looking ahead, Prof Karam emphasises the importance of improving representation of women in clinical research, increasing awareness to enable earlier referral, and developing more individualised treatment strategies that move beyond a “one-size-fits-all” approach.

Interview Questions:

1. How do sex‑specific differences in presentation and risk profile change the way you assess women being considered for structural or valvular intervention?
2. In practical terms, how does female anatomy influence your procedural planning and device selection in daily structural work?
3. Within the Heart Team, how often do sex‑related considerations actually change your final decision between surgery, transcatheter therapy and conservative management?
4. Could you share one or two recent cases where paying closer attention to a woman’s clinical and anatomical profile clearly improved the outcome of a structural intervention?
5. What simple, everyday steps can clinicians take to better integrate sex‑specific factors into their routine assessment of complex valve patients?
6. Looking at practice in 2026, where do you see the biggest opportunity to tailor structural interventions more precisely to individual women rather than using a ‘one‑size‑fits‑all’ approach?

Editors: Jordan Rance
Videographer: David Ben-Harosh
Support: This is an independent interview produced by Radcliffe Cardiology.