Sex-based differences in TAVR patients have been reported, suggesting a survival advantage in women compared to men. Yet, data on TAVR outcomes stratified by gender in our region are limited. The objective of this study is to evaluate sex-based differences in medical history, pre-operative assessment, and 30-days and one-year outcomes among patients undergoing TAVR.

Methods and results: we conducted a retrospective analysis including patients with symptomatic severe aortic stenosis who underwent TAVR at a university hospital between 2015 and 2022. The primary endpoint was assessed using the Valve Academic Research Consortium 2 (VARC-2) safety endpoint, a composite of all-cause mortality, stroke, myocardial infarction (MI), major vascular complication, life-threatening bleeding, and stage 2 or 3 acute kidney injury at 30 days. The secondary endpoint was the VARC-2 efficacy endpoint, a composite of all-cause mortality, stroke, MI, and hospitalization for decompensated heart failure at 1 year. Data are reported as median and interquartile range [IQR] or number and percentage (%). Kaplan-Meier curves for event-free survival were constructed to illustrate event-free survival over time for the composite endpoint, with comparisons performed using log-rank analysis.

We included 333 patients, 190 (57%) were women while 143 (43%) were men. Median age was 84 [79-87] years old and median STS score was 4% [2.7-6.2%]. No significant disparities in cardiovascular risk factors were observed between genders. Compared to men, women had a lower prevalence of peripheral artery disease (21 (11%) vs 32 (22%); p=0.005) and previous coronary artery disease (11 (6%) vs 50 (35%); p<0.001). 

There were no differences in baseline echocardiogram parameters between genders. Cardiac CT showed a statistically significant lower calcium score (2499 [1714-3666] Agatston Units (AU) versus 2947 [2059-4041] AU, p=0.013), smaller aortic annulus perimeter (75 [72-80] mm versus 82 [78-87] mm, p<0.001) and smaller aortic annulus area (410 [369-463] mm2 versus 482 [442-531] mm2, p<0.001) in women compared to men. Among the 262 patients who underwent pre-TAVR coronary angiography, women were less likely to present with significant coronary stenosis compared to men (32% vs. 59%, p=0.004).

Regarding the TAVR procedure, transfemoral approach was the most frequently used in both genders. Patients with small aortic annulus (defined as aortic annulus area ≤430 mm2) were statistically significantly more likely to be women (111 (80%) vs 27 (20%), p<0.0001) and supra-annular valves were most frequently employed among them.

No differences in 30 days VARC-2 safety endpoint were observed between women and men (31 (16%) vs 16 (11%), p Log Rank=0.93, respectively) or in VARC-2 efficacy endpoint at 1 year follow-up (32 (17%) vs 18 (20%), p Log Rank=0.55).

Conclusions: women who underwent TAVR had a lower prevalence of coronary artery disease, were more likely to have smaller annulus and received supra-annular valve implants more frequently compared to men. Yet, no differences at 30 days and 1 year follow-up VARC-2 safety and efficacy outcomes were observed among genders.