TY - JOUR
T1 - Sex differences in hemodynamics and outcomes after transcatheter aortic valve replacement
AU - Guthoff, Henning
AU - Abdel-Waha, Mohamed
AU - IMPPACT TAVR Investigators
AU - Kim, Won Keun
AU - Wienemann, Hendrik
AU - Shamekhi, Jasmin
AU - Eckel, Clemens
AU - von der Heide, Ina
AU - Veulemans, Verena
AU - Landt, Martin
AU - Schewel, Jury
AU - Van Mieghem, Nicolas M.
AU - Adrichem, Rik
AU - Toggweiler, Stefan
AU - Rheude, Tobias
AU - Macherey-Meyer, Sascha
AU - Bleiziffer, Sabine
AU - Al-Kassou, Baravan
AU - Nienaber, Stephan
AU - Wrobel, Jan
AU - Richter, Ines
AU - Möllmann, Helge
AU - Renker, Matthias
AU - Charitos, Efstratios
AU - Schofer, Niklas
AU - Zeus, Tobias
AU - Schmidt, Tobias
AU - von Stein, Philipp
AU - Thiele, Holger
AU - Witberg, Guy
AU - Adam, Matti
AU - Baldus, Stephan
AU - Rudolph, Tanja K.
AU - Mauri, Victor
AU - Thurow, Maria
AU - Tarantini, Giuseppe
AU - Tamburino, Corrado
AU - Ruile, Philipp
AU - Rück, Andreas
AU - Potratz, Max
AU - Pellegrini, Costanza
AU - Pauly, Markus
AU - Nombela-Franco, Luis
AU - Nickenig, Georg
AU - Mylotte, Darren
AU - Mons, Ute
AU - Meertens, Max M.
AU - Ludwig, Sebastian
AU - Lohner, Valerie
AU - Lee, Samuel
AU - Kelm, Malte
N1 - Publisher Copyright:
© The Author(s) 2025.
PY - 2025/11/20
Y1 - 2025/11/20
N2 - Background: Women remain underrepresented in transcatheter aortic valve replacement (TAVR) trials, despite well-recognized anatomical differences that necessitate tailored procedural strategies. This study assessed sex-specific differences in baseline characteristics, procedural approaches, hemodynamic outcomes, and their impact on 5-year all-cause mortality. Methods: We analyzed data from 20,094 patients in the IMPPACT TAVR registry. Hemodynamic outcomes, including prosthesis-patient mismatch (PPM), were defined according to Valve Academic Research Consortium-3 criteria. Kaplan–Meier and Cox models assessed 5-year all-cause mortality, and logistic regression identified predictors of PPM. Results: Women comprised 49.1% of the cohort. They were older (81.4 vs. 80.2 years, p < 0.001), more symptomatic (NYHA ≥ III: 74.4% vs. 67.6%, p < 0.001), and more frequently received self-expanding valves (66.5% vs. 45.7%, p < 0.001). Post-TAVR indexed effective orifice areas were slightly larger in women (1.01 ± 0.28 vs. 0.99 ± 0.27cm2/m2, p < 0.001). Five-year mortality was lower in women (HR 0.81, 95% CI 0.76–0.86, p < 0.001). Severe PPM occurred less frequently in women (4.0% vs. 4.5%, p < 0.001) and was associated with increased mortality only in men (HR 1.32, 95% CI 1.10–1.59, p = 0.002). Adjustment for comorbidities nullified the association between PPM and mortality in both sexes. Conclusions: In this international TAVR cohort, women, despite being older, demonstrated better survival than men, with comparable postprocedural hemodynamic outcomes. Severe PPM was associated with increased mortality only in men, likely reflecting underlying comorbidities and low-flow states. After adjustment for confounders, PPM was no longer associated with survival in either sex. These findings underscore the need for strategies accounting for both procedural and patient-specific risks, beyond prosthesis hemodynamics.
AB - Background: Women remain underrepresented in transcatheter aortic valve replacement (TAVR) trials, despite well-recognized anatomical differences that necessitate tailored procedural strategies. This study assessed sex-specific differences in baseline characteristics, procedural approaches, hemodynamic outcomes, and their impact on 5-year all-cause mortality. Methods: We analyzed data from 20,094 patients in the IMPPACT TAVR registry. Hemodynamic outcomes, including prosthesis-patient mismatch (PPM), were defined according to Valve Academic Research Consortium-3 criteria. Kaplan–Meier and Cox models assessed 5-year all-cause mortality, and logistic regression identified predictors of PPM. Results: Women comprised 49.1% of the cohort. They were older (81.4 vs. 80.2 years, p < 0.001), more symptomatic (NYHA ≥ III: 74.4% vs. 67.6%, p < 0.001), and more frequently received self-expanding valves (66.5% vs. 45.7%, p < 0.001). Post-TAVR indexed effective orifice areas were slightly larger in women (1.01 ± 0.28 vs. 0.99 ± 0.27cm2/m2, p < 0.001). Five-year mortality was lower in women (HR 0.81, 95% CI 0.76–0.86, p < 0.001). Severe PPM occurred less frequently in women (4.0% vs. 4.5%, p < 0.001) and was associated with increased mortality only in men (HR 1.32, 95% CI 1.10–1.59, p = 0.002). Adjustment for comorbidities nullified the association between PPM and mortality in both sexes. Conclusions: In this international TAVR cohort, women, despite being older, demonstrated better survival than men, with comparable postprocedural hemodynamic outcomes. Severe PPM was associated with increased mortality only in men, likely reflecting underlying comorbidities and low-flow states. After adjustment for confounders, PPM was no longer associated with survival in either sex. These findings underscore the need for strategies accounting for both procedural and patient-specific risks, beyond prosthesis hemodynamics.
UR - https://www.scopus.com/pages/publications/105025121263
U2 - 10.1007/s00392-025-02794-2
DO - 10.1007/s00392-025-02794-2
M3 - Article
C2 - 41264012
AN - SCOPUS:105025121263
SN - 1861-0684
JO - Clinical Research in Cardiology
JF - Clinical Research in Cardiology
ER -