Sex-specific differences in procedural complications and in-hospital mortality following transfemoral transcatheter aortic valve implantation (TAVI)

Cardiovascular diseases in women are frequently diagnosed later than in men, leading to delays in treatment and poorer outcomes. Sex-specific differences in outcomes following transcatheter aortic valve implantation (TAVI) in patients with severe symptomatic aortic stenosis have garnered significant attention in recent years. Understanding these disparities is crucial as they may influence clinical decision-making and patient management. Consequently, this study aimed to determine sex-specific differences in short-term outcomes in patients with severe aortic valve stenosis undergoing TAVI.

We systematically evaluated clinical and procedural characteristics, in-hospital mortality, and peri-interventional complications in a cohort of 1500 consecutive patients with severe aortic valve stenosis undergoing transfemoral TAVI. Subjects undergoing valve-in-valve TAVI have been excluded previously. The outcomes were compared between males and females.

Baseline characteristics significantly differed between men and women. Women were older (81 ± 6 years) compared to men (80 ± 6 years, p<0.001). Women also had higher logistic Euroscore (20 ± 13% vs. 18 ± 14%, p<0.001) and STS Score (5 ± 3% vs. 4 ± 3%, p<0.001) than men. Conversely, women had a lower incidence of previous coronary artery bypass grafting (3% vs. 6%, p<0.001) and coronary artery disease (38% vs. 45%, p<0.001), along with lower pre-procedural creatinine levels (1.0 ± 0.9 vs. 1.1 ± 0.9 mg/dl, p<0.001). 72% of subjects received a balloon-expandable valve, 28% a self-expandable valve.

In-hospital mortality was significantly higher in women (2% vs. 0.8%, p=0.002), as was cardiovascular mortality (1.5% vs. 0.6%, p=0.007). Six women required conversion to surgical aortic valve replacement (SAVR), whereas no men did (p=0.014). Women also had higher rates of myocardial infarction (0.5% vs. 0.1%, p=0.08), necessity for cardiopulmonary resuscitation (2.5% vs. 1.5%, p=0.016), pericardial tamponade (1% vs. 0.3%, p=0.007), cardiogenic shock (1.7% vs. 0.9%, p=0.026), and major bleeding (2.7% vs. 1.5%, p=0.006) than men. However, there were no significant differences in the incidence of stroke (both 1%, p=0.317), pulmonary embolism (0.1% vs. 0%, p=0.240), sepsis (0.7% vs. 1%, p=0.199), or need for permanent pacemaker implantation due to high-degree AV block (5.4% vs. 6%, p=0.415). Interestingly, new onset left and right bundle branch block after TAVI occurred more frequently in women than in men (16% vs. 11%, p<0.001 and 1.3% vs. 0.6%, p=0.033, respectively). After adjustment for age and aforementioned risk scores, the significant difference between men and women persisted for in-hospital and cardiovascular mortality.

In summary, women exhibited higher rates of in-hospital and cardiovascular mortality as well as the aforementioned complications following TAVI compared to men. This disparity may partially be attributed to older age and a higher degree of morbidity in the current cohort of women. Cardiovascular diseases in women are often diagnosed later than in men, leading to delays in treatment and poorer outcomes. Given the critical importance of early diagnosis and treatment, raising awareness about cardiovascular diseases in women is essential.