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Sex Difference in TAVR for Bicuspid Aortic Stenosis
Quick Takes
- Among patients with bicuspid aortic valves (BAVs) undergoing TAVR, female sex was associated with more vascular complications, bleeding events, and higher residual gradients, while men were more likely to undergo a second valve implantation.
- Of note, death at 30 days and 1 year was not significantly different between the sexes, but predictors of 1-year death were intrinsically different, being baseline characteristics in men and procedural complications in women.
- It appears that tailored procedural strategies may potentially benefit female patients with BAVs undergoing TAVR.
Study Questions:
What is the impact of sex on outcomes following transcatheter aortic valve replacement (TAVR) in patients with bicuspid aortic valves (BAVs)?
Methods:
The investigators included patients with BAVs undergoing TAVR for severe aortic stenosis from 2012–2021 in this retrospective single-center study. Baseline characteristics, aortic root anatomy, and in-hospital and 1-year valve hemodynamic status and survival were compared between sexes. Time-to-event variables were presented as Kaplan-Meier estimates (number of events) and were compared using the log-rank test. Cox proportional hazards models were used to assess simple and multivariable association with 1-year all-cause mortality. The interaction of sex with all variables was tested using Cox regression model.
Results:
A total of 510 patients with BAVs were included. At baseline, women presented with fewer comorbidities. Men had a greater proportion of Sievers type 1 BAV, higher calcium volumes (549.2 ± 408.4 mm3 vs. 920.8 ± 654.3 mm3; p < 0.001), and larger aortic root structures. Women experienced more vascular complications (12.9% vs. 4.9%; p = 0.002) and bleeding (11.1% vs. 5.3%; p = 0.019) and higher residual gradients (16.9 ± 7.7 mm Hg vs. 13.2 ± 6.4 mm Hg; p < 0.001), while men were more likely to undergo second valve implantations during index TAVR (6.3% vs. 15.9%; p = 0.001). Death at 1 year was not significantly different between sexes (hazard ratio [HR], 1.15; 95% confidence interval [CI], 0.56-2.35; p = 0.70). Bleeding (adjusted HR, 4.62; 95% CI, 1.51-14.12; p = 0.007) was the single independent predictor of 1-year death for women.
Conclusions:
The authors reported that in patients with BAVs undergoing TAVR, in-hospital outcomes favored men but 1-year survival was comparable between sexes.
Perspective:
This study assessed sex-specific outcome in patients with BAVs undergoing TAVR and reported that female sex was associated with more vascular complications, bleeding events, and higher residual gradients, while men were more likely to undergo a second valve implantation. Of note, death at 30 days and 1 year was not significantly different between the sexes, but predictors of 1-year death were intrinsically different, being baseline characteristics in men and procedural complications in women. While additional studies are indicated to confirm the sex-specific impact of in-hospital outcomes on the prognosis after TAVR in patients with BAVs, it appears that tailored procedural strategies may benefit female patients with BAVs undergoing TAVR.
Clinical Topics: Cardiac Surgery, Congenital Heart Disease and Pediatric Cardiology, Geriatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Prevention, Valvular Heart Disease, Aortic Surgery, Cardiac Surgery and Arrhythmias, Cardiac Surgery and CHD and Pediatrics, Cardiac Surgery and VHD, Congenital Heart Disease, CHD and Pediatrics and Arrhythmias, CHD and Pediatrics and Interventions, CHD and Pediatrics and Quality Improvement, Interventions and Structural Heart Disease
Keywords: Aortic Valve Stenosis, Bicuspid Aortic Valve Disease, Cardiac Surgical Procedures, Geriatrics, Heart Valve Diseases, Heart Valve Prosthesis, Hemodynamics, Hemorrhage, Outcome Assessment, Health Care, Secondary Prevention, Sex Characteristics, Transcatheter Aortic Valve Replacement, Vascular Diseases
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