Sex differences in patient-reported and clinical outcomes after valve-in-valve TAVI: Insights from the Australian ACOR registry

BACKGROUND Valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) is an established treatment for failed surgical bioprostheses, but sex-specific patient-reported outcomes (PROMs) are poorly characterised. METHODS We analysed ViV-TAVI procedures in the prospective Australian Cardiac Outcomes Registry. PROMs (KCCQ-12 Overall and Clinical Summary Scores, EQ-5D-3L index and EQ-VAS) were collected at baseline, 30 days, and 12 months. Longitudinal change by sex was evaluated with linear mixed-effects models, and 12-month MACCE and valve haemodynamics were compared using regression and propensity-matched analyses. RESULTS Among 1050 ViV-TAVI patients (359 females), PROMs improved by 30 days and were sustained to 12 months. KCCQ-12 Overall Summary Score increased by about 36 points and Clinical Summary Score by 29-30 points (both p < 0.001), with parallel trajectories in females and males. EQ-5D-3L and EQ-VAS likewise improved without sex interaction, and findings were consistent in a matched cohort. Females had higher MACCE at 30 days (5.3% vs 1.7%, p = 0.002) and 12 months (12.2% vs 5.4%, p = 0.001), driven by more strokes (4.5% vs 1.2%, p = 0.010), despite comparable 12-month valve haemodynamics. CONCLUSIONS ViV-TAVI yields large and sustained gains in health status in both sexes, but females remain at higher risk of MACCE and stroke.