Key result
In adults with severe aortic stenosis, the choice between transcatheter and surgical aortic valve replacement should account for expected longevity, which is greater in women than men.
Why the study?
In adults with severe aortic stenosis, sex and age differences in symptoms and diagnosis may lead to delays in intervention, and choice of intervention partly depends on expected longevity.
Treatment choice for severe aortic stenosis should account for sex-specific factors, including women's longer life expectancy, smaller annuli, and higher risk of vascular complications with TAVI.
Answers are grounded in this paper and cite their sources.
May warrant sex-specific longevity considerations in severe AS valve choice; leaves open need for sex-stratified randomized trials.
In adults with severe aortic stenosis, sex and age differences in symptoms and diagnosis may lead to delays in intervention. Choice of intervention partly depends on expected longevity because bioprosthetic valves have limited durability, particularly in younger patients. Current guidelines recommend the following: a mechanical valve in younger adults (aged <50 years) if lifelong anticoagulation is possible and acceptable and a valve-sparing procedure is not possible; surgical mechanical or bioprosthetic aortic valve replacement (SAVR) in adults aged 50-65 years; and transcatheter aortic valve implantation (TAVI) for those aged >80 years based on lower mortality and morbidity compared to SAVR and adequate valve durability. For patients aged 65-80 years, the choice between TAVI and a bioprosthetic SAVR depends on expected longevity, which is greater in women than men, as well as associated cardiac and noncardiac conditions, valvular and vascular anatomy, estimated risk of SAVR versus TAVI and expected complications and patient preferences.
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Rashedi et al. (2022) conducted a review in Severe Aortic Valve Stenosis. Aortic valve replacement (SAVR vs TAVI) was evaluated. In adults with severe aortic stenosis, the choice between transcatheter and surgical aortic valve replacement should account for expected longevity, which is greater in women than men.
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