Sex-specific differences in outcomes of transcatheter aortic-valve implantation (TAVI)

Introduction Differences in baseline characteristics and anatomy between female and male patients with aortic-valve stenosis may influence outcomes after TAVI. Female gender has been linked to increased risk of periprocedural adverse events which contrasts with paradoxically more favorable long-term outcomes. Purpose To compare perioperative outcomes and 1-year mortality after TAVI in women versus men. Methods Our retrospective monocentric study included 652 consecutive patients (343 women, 52.6%) with severe, symptomatic aortic stenosis who underwent TAVI from January 2010 to July 2017. Results Women were likely to be older with lower rate of known coronaropathy, peripheral arteriopathy and past cardiac surgery. The 30-day mortality was not significantly different between women (7.3%) and men (7.4%) group, P = 0.940. During the postoperative course, VARC-2 major vascular complications (15.7% in women group versus 14.2% in men group, P = 0.592) and major bleeding composite criteria (BARC type 3b, 3c and 5) (17.5% versus 17.2%, P = 0.909) did not significantly differ between two groups. The incidence of 1-year all-cause mortality was 16.3% (n = 56) in women and 23.9% (n = 74) in men group, P = 0.015. After multivariate analysis, the only independent predictors of 1-year mortality were acute heart failure at admission (adjusted HR 1.83, 95% CI [1.23 to 2.72], P = 0.003) and femoral access (adjusted HR 0.48, 95% CI [0.32 to 0.70], P  Conclusions The 1-year all-cause mortality was lower in women than men after TAVI, with similar perioperative outcomes. After multivariate analysis, initial acute heart failure and femoral access were independent predictors of 1-year mortality but not gender.