Sex differences in postprocedural aortic regurgitation and mid-term mortality after transcatheter aortic valve implantation.

BACKGROUND: The impact of female sex on mortality after transcatheter aortic valve implantation (TAVI) is controversial. Post-procedural aortic regurgitation (AR) ≥ 2 has been associated with poor outcomes. Whether sex differences in post-procedural AR ≥ 2 could contribute to a mortality difference between women and men is not known.

METHODS: Six hundred fifty-six patients, women (53.1%), men (46.9%), with aortic stenosis underwent TAVI with the CoreValve system (92.8%) or the Edwards SAPIEN valve system (7.2%). AR was graded semiquantitatively as 0 = none, 1 = trivial, 2 = mild, 3 = moderate, and 4 = severe. The incidence of post-procedural AR ≥ 2 was reported.

RESULTS: Procedural success was similar in women as compared to men (97.9 vs 96.7%, P = 0.32). Post-procedural AR ≥ 2 occurred less frequently in women than in men (20.9 vs 29.6%, P = 0.01). After a median follow-up of 434 days, all-cause mortality tended to be lower in women than in men (20.7 vs 26.6%, logrank P = 0.10), and was significantly higher in patients with AR ≥ 2 than in those without (34.8 vs 19.7%, logrank P < 0.001). AR ≥ 2 [hazard ratio (HR) 1.73, 95% confidence interval (CI) 1.22-2.43, P = 0.002], but not female sex (P = 0.17) was an independent predictor of all-cause death at multivariable Cox regression. The predictive value of AR ≥ 2 was restricted to men (HR 2.96, P < 0.001 among men; HR 0.86, P = 0.60 among women; P for interaction = 0.002).

CONCLUSIONS: Women, as compared to men, present a trend toward lower mortality. A significant lower incidence of post-procedural AR ≥ 2 among women contributes to this finding. Female sex, however, was not a significant independent predictor of death.