Sex-Specific Differences in Outcome of Transcatheter or Surgical Aortic Valve Replacement

Background: Differences in baseline characteristics and anatomy between female and male patients with aortic valve stenosis may influence outcomes after surgical and transcatheter aortic valve replacement (TAVR). We evaluated the effect of sex on in-hospital outcomes after transfemoral (TF-TAVR), transapical (TA-TAVR), or surgical (SAVR) aortic valve replacement in a nationwide cohort.

Methods: Baseline characteristics and outcomes from all isolated TAVR or SAVR procedures performed between 2011 and 2014 in German hospitals were analyzed (N = 64,794). Primary outcome was in-hospital mortality. Unadjusted and adjusted comparisons between women and men were performed within each treatment group.

Results: Females were generally older and had a higher EuroSCORE. Thus, they were preferentially treated with TF-TAVR, whereas the share of TF-TAVR and SAVR was similar in males. Females suffered more relevant bleeding after TF-TAVR and SAVR (TF-TAVR: adjusted odds ratio [aOR] = 1.16, P = 0.018; TA-TAVR: aOR = 0.98, P = 0.799; SAVR: aOR = 1.12, P = 0.005). However, prolonged postoperative ventilation was less frequently necessary in females (aOR TF-TAVR: 0.69, P < 0.001; TA-TAVR: 0.69, P < 0.001; SAVR: 0.76, P < 0.001) and stroke risk was lower (TA-TAVR: aOR = 0.60, P = 0.001; TF-TAVR: aOR = 0.74, P = 0.001; SAVR: aOR = 0.61, P < 0.001). In-hospital mortality was slightly decreased in females undergoing TF-TAVR after adjustment (aOR = 0.87, P = 0.047), and equal in TA-TAVR (aOR = 0.96, P = 0.640) or SAVR (aOR = 1.02, P = 0.807).

Conclusions: This nation-wide analysis of sex-specific outcomes after aortic-valve replacement procedures showed that women are higher-risk for bleeding, but lower-risk for stroke, mechanical ventilation, and TF-TAVR mortality. Understanding these differences and their basis may help improve outcomes.