Effect of sex differences on one-year mortality after transcatheter aortic valve implantation for severe aortic stenosis: results from a multi-centre real-world registry

Abstract

Objectives: The aim of this analysis is to examine the influence of sex differences on the outcome after transcatheter aortic valve implantation (TAVI) from a multi-centre real-world registry in Germany (TAVI-Registry). Background: The impact of sex differences on the clinical outcome after TAVI was examined in small studies with conflicting rersults. Methods: Consecutive patients (n=1432) undergoing TAVI in the period between January 2009 and June 2010 in Germany, were evaluated. Differences in all-cause mortality were examined with Kaplan-Meier estimates and proportional hazards models. Results: Women comprised 57.8% of the cohort. The Edwards-Sapien valve (18.5%) and CoreValve (81.5%) were used through the transfemoral (87.7%), subclavian (3.0%), transapical (8.6%), or transaortic approach (0.7%). At baseline, women had higher aortic gradients and were older. Men had more comorbidities: prior myocardial infarction, prior revascularization, prior coronary artery bypass surgery, peripheral arterial vascular disease and chronic obstructive pulmonary disease. Women had more periprocedural vascular complications in comparison to men (25.2% vs. 17.2%, p <0.001). There was no significant difference in mortality at 30-day follow up (7.6% for women vs. 8.6% for men, p=0.55). The adjusted odds ratio for one-year all-cause mortality favored women, 0.73 (95% confidence interval: 0.58 to 0.9) with mortality rate 17.3% versus 23.6% for men. Conclusions: Female sex is associated with better one-year survival after TAVI. These results suggest that TAVI might be the preferred treatment option for elderly women with symptomatic severe aortic stenosis.