Sex Differences Among Patients With Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement: A...

This study aimed to elucidate gender differences in cardiac function among patients undergoing aortic valve replacement (TAVR) for severe aortic stenosis (AS) and to clarify their clinical implications for outcomes.

We retrospectively evaluated 550 consecutive patients with severe AS treated between January 2017 and August 2022. Patients with hemodialysis, valve-in-valve procedures, and unsuccessful procedures were excluded.

The final study cohort included 514 patients who underwent successful TAVR (84 ± 5 years, 339 females). Female patients had a smaller physique and fewer atherosclerotic diseases, and chronic obstructive pulmonary diseases. Sizes of left ventricle and aortic valve were smaller in women even after the corrections by physique. Additionally, in women, left ventricular diastolic function indices such as eft atrial volume index (LAVI) and E/e' were deteriorated, while left ventricular remodeling expressed by relative wall thickness (RWT) and the clinical AS stage were more advanced. There were no sex differences in 1-year outcomes of TAVR. However, multiple regression analyses revealed that predictors for cardiovascular events in women were clinical frailty scale, LAVI and RWT (odds ratio [OR]: 1.57, p = 0.017; OR: 1.01, p = 0.020; OR: 45.21, p < 0.001; respectively), whereas predictors in men were atrial fibrillation and past smoking (OR: 4.01, p = 0.008; OR: 2.88, p = 0.049; respectively).

Women TAVR recipients had worse left ventricular diastolic function and left ventricular remodeling, which had significant impacts on the TAVAR outcomes. Early interventions may be beneficial especially for women.