Sex-based differences in long-term mortality after TAVR among patients with bicuspid aortic valve.

BACKGROUND

Sex-related disparities after transcatheter aortic valve replacement (TAVR) have been described in tricuspid aortic stenosis, but long-term data in bicuspid aortic valve (BAV) stenosis remain limited.

AIMS: To evaluate sex-based differences in long-term mortality and predictors of outcomes after TAVR in patients with BAV stenosis.

METHODS

We retrospectively analyzed 327 patients with BAV stenosis (183 men, 144 women) who underwent TAVR from 2014 to 2025. Baseline, anatomic, procedural, and clinical outcomes were compared by sex. Cox models evaluated predictors of all-cause mortality and exploratory sex interactions.

RESULTS

Over a median follow-up of 4.5 years by reverse Kaplan-Meier analysis, 93 deaths occurred (57 men, 36 women). Men had more coronary artery disease and greater aortic valve calcium burden than women (median 3519 vs 1815 AU; p < 0.001). Long-term mortality did not differ significantly by sex, although a nonsignificant late trend toward worse survival was observed in men (31.1% vs 25.0%; log-rank p = 0.095). Older age independently predicted mortality, while higher STS score and prior CABG demonstrated borderline associations. Exploratory interaction analyses identified sex interactions for eGFR (HR 0.965, 95% CI 0.944-0.987; p = 0.002) and diabetes (HR 0.217, 95% CI 0.076-0.620; p = 0.004). Higher eGFR was associated with lower mortality among women, whereas diabetes was associated with mortality among men.

CONCLUSIONS

Long-term mortality after TAVR for BAV stenosis did not differ significantly by sex. Exploratory findings suggest selected clinical comorbidities may be more informative than the anatomic parameters evaluated in this cohort.