Age and sex-related outcomes in cardiovascular magnetic resonance versus computed tomography-guided transcatheter aortic valve replacement: a secondary analysis of a randomized clinical trial.

BACKGROUND: Transcatheter aortic valve replacement (TAVR) is the preferred treatment for older patients with severe aortic stenosis with outcomes influenced by age and sex. Computed tomography (CT) is the reference imaging modality for TAVR planning, while cardiovascular magnetic resonance (CMR) is an emerging alternative for this indication. The aim of this study was to evaluate the impact of age and sex on implantation success in patients undergoing CT- or CMR-guided TAVR.

METHODS: This was a secondary analysis of the randomized TAVR-CMR trial comparing TAVR planning by CT or CMR (NCT03831087). Patients were categorized according to the median age (82 years) and sex. Implantation success, defined using the Valve Academic Research Consortium-2 definition (absence of procedural mortality, correct positioning of a single prosthetic valve, and proper prosthetic valve performance), was compared at hospital discharge between age groups and sex for each imaging strategy. All-cause mortality at 6 months was compared between imaging strategies across age groups and sex.

RESULTS: A total of 267 patients (median age 82 [IQR 80-85] years, 50% (133/267) female) underwent TAVR at two heart centers in Austria between September 2017 and December 2022. Implantation success did not differ significantly between imaging strategies across age and sex subgroups. For patients ≤82 years, success rates were 92.1% (58/63) (CT) vs. 94.7% (72/76) (CMR) (p=0.524), and for those >82 years, 89.4% (59/66) (CT) vs. 91.9% (57/62) (CMR) (p=0.622). Among female patients, success rates were 84.7% (50/59) (CT) vs. 93.2% (69/74) (CMR) (p=0.113), and among male patients, 95.7% (67/70) (CT) vs. 93.8% (60/64) (CMR) (p=0.610). All-cause mortality at 6 months did not differ significantly between imaging strategies across age and sex subgroups. Mortality rates for patients ≤82 and >82 years were 4.8% (3/63) vs. 5.3% (4/76) (p=0.839) and 9.1% (6/66) vs. 12.9% (8/62) (p=0.490) for CT and CMR, respectively. Similarly, female and male patients had comparable mortality rates (10.2% (6/59) vs. 8.1% (6/74), p=0.680; 4.3% (3/70) vs. 9.4% (6/64), p=0.240).

CONCLUSION: In this secondary analysis of the TAVR-CMR trial, CMR-guided TAVR was associated with similar outcomes compared with CT-guided TAVR irrespective of age and sex.