Sex-Based Differences in Outcomes With Transcatheter Aortic Valve Therapy

Abstract

Female patients undergoing TAVR had a different risk profile compared with male patients. Notwithstanding a greater adjusted risk for in-hospital vascular complications, 1-year adjusted survival was superior in female patients.

Sex Differences in the Utilization and Outcomes of Surgical Aortic Valve Replacement for Severe Aortic Stenosis

“…The discussion of our findings would be incomplete without alluding to the emerging data demonstrating superior outcomes of TAVR in women compared with men and a higher magnitude of benefit of TAVR versus surgical AVR in women than in men 1, 14, 24, 33. A large report from the ACC/TVT registry examined sex differences among 11 808 patients who underwent TAVR and found no difference in in‐hospital mortality in women versus men after TAVR but significantly better 1‐year mortality in women versus men (adjusted hazard ratio: 0.73; 95% CI, 0.63–0.85; P <0.001) 14.…”

“…A large report from the ACC/TVT registry examined sex differences among 11 808 patients who underwent TAVR and found no difference in in‐hospital mortality in women versus men after TAVR but significantly better 1‐year mortality in women versus men (adjusted hazard ratio: 0.73; 95% CI, 0.63–0.85; P <0.001) 14. Similarly, in a patient‐level meta‐analysis including 11 310 patients, women had similar mortality to men at 30 days but had significantly better long‐term survival (adjusted hazard ratio: 0.79; 95% CI, 0.73–0.86; P =0.001), despite higher rates of in‐hospital complications 1.…”

“…The interest in examining the sex gap in AS patients has been renewed with the introduction and widespread adoption of transcatheter AVR (TAVR). Recently, a report from the American College of Cardiology (ACC) and TVT registry and a large meta‐analysis showed superior outcomes with TAVR in women compared with men 1, 14. We hypothesized that female patients have worse outcomes following AVR compared with propensity‐matched male patients.…”

Transcatheter Aortic Valve Replacement in Women

“…1 Subsequently, multiple investigators have sought to define gender disparities in patients undergoing TAVR (Table I). [2][3][4][5][6][7] Early studies were predominantly single-center, real-world observational studies with relatively small sample sizes; nonetheless, some similar findings emerged. In terms of preoperative characteristics, female patients tended to have smaller body surface areas, smaller aortic annular diameters, and higher left ventricular ejection fractions (LVEF) ( Table II).…”

“…Chandrasekhar and Table II shows the baseline demographic, clinical, and anatomic differences among men and women. 7 Women were more likely to undergo nontransfemoral access during TAVR and to need smaller valves. In-hospital vascular sequelae were significantly higher in women, who also showed a trend toward more bleeding events.…”