Sex-Based Differences in Hemodynamic Response to Anesthesia Type During TAVI and Early Transvalvular Gradient Changes

Background and Objectives: Anesthesia type may influence early hemodynamics post-transcatheter aortic valve implantation (TAVI), but sex-based differences in anesthetic response remain underexamined. We aimed to assess whether male and female patients exhibit differential responses to general anesthesia (GA) versus monitored anesthesia care (MAC) during TAVI, with particular attention to post-procedural transvalvular gradient changes. Methods: We conducted a single-center retrospective cohort study of 693 patients who underwent TAVI between 2011 and 2023 with complete echocardiographic and anesthesia data. Patients were categorized into four groups by sex and anesthesia type: GA-Male, MAC-Male, GA-Female, and MAC-Female. Hemodynamic, anesthetic, echocardiographic characteristics, and 6-month outcomes were compared. Results: Significant differences were observed across the four sex-anesthesia groups in several hemodynamic and echocardiographic measures. Initial analyses showed that female patients had significantly higher 24 h post-TAVI transvalvular mean gradient delta values compared to males, and among MAC patients, females also had higher 30-day mean gradients. However, secondary analyses revealed that valve size differed significantly between groups and was a key driver of these hemodynamic differences. After adjusting for valve size in a multivariable regression model, gradient differences between groups were no longer statistically significant. Net fluid balance and vasopressor use were more strongly associated with anesthesia type than sex, with GA groups requiring greater support. No significant differences in 6-month cardiovascular outcomes were observed. Conclusions: Early post-TAVI transvalvular gradient changes appeared to be primarily influenced by valve size rather than sex or anesthesia type alone. These findings suggest previously observed sex-based differences may reflect underlying disparities in valve sizing, highlighting need for further prospective studies assessing the independent contributions of sex, anesthesia modality, and valve size on early valve performance/long-term outcomes.