Key result
Female gender predicts ~53% higher 30-day TAVR mortality and more vascular complications, despite similar 1-year survival.
Why the study?
Gender disparities in mortality and vascular complications have been shown after TAVR with early generation valves, but it remains unclear whether these differences persist with newer generation transcatheter heart valves.
Does female gender increase mortality and vascular complications in patients undergoing TAVR with newer generation THVs compared to male gender?
Meta-Analysis (n=47,933)
Does female gender increase mortality and vascular complications in patients undergoing TAVR with newer generation THVs compared to male gender?
Despite the use of newer generation transcatheter heart valves, female patients continue to experience higher 30-day mortality and vascular complications compared to males, though 1-year mortality is similar.
Females incur higher short-term TAVR risks despite newer valves; confirms persistent sex differences and supports targeted mitigation research.
Previous studies have demonstrated gender disparities in mortality and vascular complications after transcatheter aortic valve replacement (TAVR) with early generation transcatheter heart valves (THVs). It is unclear, however, whether gender-related differences persist with the newer generation THVs. We aim to assess gender disparities after TAVR with newer generation THVs. The MEDLINE and Embase databases were thoroughly searched from inception to April 2023 to identify studies that reported gender-specific outcomes after TAVR with newer generation THVs (Sapien 3, Corevalve Evolut R, and Evolut Pro). The outcomes of interest included 30-day mortality, 1-year mortality, and vascular complications. In total, 5 studies (4 databases) with a total of 47,933 patients (21,073 females and 26,860 males) were included. Ninety-six percent received TAVR via the transfemoral approach. The females had higher 30-day mortality rates (odds ratio (OR) = 1.53, 95% confidence interval (CI) 1.31–1.79, p-value (p) < 0.001) and vascular complications (OR = 1.43, 95% CI 1.23–1.65, p < 0.001). However, one-year mortality was similar between the two groups (OR = 0.78, 95% CI 0.61–1.00, p = 0.28). The female gender continues to be associated with higher 30-day mortality rates and vascular complications after TAVR with newer generation transcatheter heart valves, while there was no difference in 1-year mortality between the genders. More data is needed to explore the causes and whether we can improve TAVR outcomes in females.
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Trongtorsak et al. (2023) conducted a meta-analysis in Aortic valve disease requiring TAVR (n=47,933). Female gender vs. Male gender was evaluated on 30-day mortality (OR 1.53, 95% CI 1.31-1.79, p=< 0.001). Female gender was associated with higher 30-day mortality (OR 1.53; 95% CI 1.31-1.79; p<0.001) and vascular complications after TAVR with newer generation valves, but 1-year mortality was similar.
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