Sex-Related Differences After Transcatheter Aortic Valve Implantation: A Retrospective Propensity-Matched Cohort

Sex differences in outcomes after transcatheter aortic valve implantation (TAVI) remain incompletely understood. Earlier studies described a "sex paradox," with women experiencing more procedural complications but similar or superior survival compared with men. However, most data derive from earlier device generations, and contemporary evidence is limited.

We retrospectively analysed all patients with severe aortic stenosis who underwent TAVI at the University Hospital of Angers between January 2012 and December 2023. Clinical and procedural characteristics were collected from a dedicated database. Propensity-score matching (1:1) was performed to account for baseline differences. The primary end-point was 30-day mortality.

A total of 2718 patients underwent TAVI, of whom 49.1% were women. Women were older but had fewer comorbidities than men. After matching (1320 pairs), procedural duration was similar, but women more often required alternative access and received self-expandable valves. Thirty-day mortality did not differ between sexes, but all-cause mortality was significantly higher in men (P < .01). Women had a greater incidence of postoperative stroke, particularly in low-risk patients, whereas men had higher rates of acute renal failure and pacemaker implantation. The survival probability was higher for women in overall population and in low- and intermediate-risk patients.

In this large, contemporary cohort, women experienced more strokes, whereas men had higher all-cause mortality and conduction-related complications. These findings underscore persistent sex-specific differences in TAVI outcomes and highlight the need for tailored procedural strategies.