Long-Term Impact of Gender Differences After Transcatheter Aortic Valve Implantation

The short-term and midterm impact of gender differences on transcatheter aortic valve implantation (TAVI) has been studied. However, the impact on long-term clinical outcomes remains unclear. The objective of the study was to investigate the impact of gender differences after TAVI on long-term clinical outcomes and structural valve deterioration (SVD).

Of the 672 consecutive patients who underwent TAVI, with balloon- or self-expandable valves, between 2013 and 2018, a total of 511 who underwent multidetector computed tomography analysis within 30 days after TAVI were included. Echocardiographic data were analyzed annually.

The number of women was 343 (67.2%), and 90.7% of them had a small annulus (< 430 mm²). The effective orifice area was significantly smaller in women compared with that in men, whereas no difference occurred in the incidence of prosthesis-patient mismatch. The incidence of leaflet thrombosis detected by multidetector computed tomography was similar for women vs men (15.2% vs 13.1%, respectively; P = 0.53). During the median follow-up of 1844 days (interquartile range: 1190-2311 days), women showed a significantly decreased incidence of all-cause mortality (hazard ratio, 0.69; 95% confidence interval, 0.54-0.90; P = 0.005). The development of SVD was comparable (hazard ratio, 0.99; 95% confidence interval, 0.78-1.25, P = 0.90). Severe frailty and the balloon-expandable valves were the independent risk factors for all-cause mortality and SVD in women, respectively.

Women had superior long-term clinical outcomes, compared with those of men, despite their having a small annulus. During long-term follow-up, the incidence of SVD in women was similar in the entire cohort, compared to that in men; however, balloon-expandable valves were possible risk factors for SVD in women.