Abstract 13118: Sex Disparities in Hemodynamics and Outcomes Among Women Undergoing Contemporary Transcatheter Aortic Valve Replacement

Abstract

Introduction: Several studies have demonstrated worse outcomes following transcatheter aortic valve replacement (TAVR) in women compared to men using early transcatheter heart valves (THV). Different THV designs impact hemodynamics in patients with small annuli and women constitute the majority of these patients. Hypothesis: We hypothesized that women represent the majority of patients with small annuli resulting in worse hemodynamics. Methods: We examined patients with symptomatic severe aortic stenosis who underwent TAVR using contemporary THVs across all surgical risk categories. We compared baseline characteristics, procedural details, in-hospital outcomes, and hemodynamics (30-day) according to sex. We then performed a secondary analysis focusing on the female patients, dichotomizing them based on aortic annular area above or below 430mm 2 . Results: Included were a total of 869 patients who underwent TAVR using a contemporary THV. The majority of patients with an annular area <430mm 2 were female (82.5%) and most with an annular area >430mm 2 were male (76.8%). Females saw a trend towards higher 30-day (1.5% vs. 0.6%; p=0.313) and 1-year (4.1% vs. 2.7%; p=0.265) mortality. Females with an annular area <430mm 2 who received an self-expanding THV saw lower mean gradients at 30 days compared to those who received a balloon-expandable THV (8.0mmHg vs. 13.8mmHg; p<0.001) which resulted in lower rates of moderate patient prosthesis mismatch (PPM) (21.2% vs. 73.6%; p<0.001). A similar trend was seen in females with an annular area >430mm 2 who received a self-expanding THV (9.3mmHg vs. 11.5mmHg; p<0.001) which resulted in lower rates of moderate PPM as well (24.5% vs. 59.2%; p<0.001). Conversely, female patients who received a self-expanding THV saw higher rates of permanent pacemaker implantation regardless of annular size. Conclusions: Female patients undergoing contemporary TAVR saw numerically higher short-term mortality which could be, a result of higher rates of PPM. These findings were more pronounced in the subset of females with small aortic annuli, where those who received a self-expanding THV demonstrated superior hemodynamics but at the cost of increased rates of permanent pacemaker implantation.