Background
It has previously been described that female patients experience worsened access to valve intervention for severe aortic stenosis than males. It remains unclear whether there is also a discrepancy in clinical outcomes by sex following transcatheter aortic valve intervention (TAVI). Previous studies in this area are discordant and largely non-UK based. Purpose
To examine the effect of biological sex on outcomes following TAVI in a large, continuous, cohort of patients treated at a tertiary referral centre in the UK over the last 10 years. Methods
A retrospective analysis of 1049 patients (46.8% female) undergoing TAVI from 2013 to 2023 was conducted. Local data was submitted to the National Institute for Cardiovascular Outcomes Research (NICOR) TAVI database. Primary outcomes included death and composite 3-point major adverse cardiac events (MACE) (death, from any cause, non-fatal myocardial infarction, and stroke) before discharge during TAVI admission. Post-TAVI survival time was also assessed. Categorical variables were compared using Chi-squared and continuous variables using student's t-test. Cox regression analysis was performed for independent predictors of survival. Outcomes were adjusted using multivariate regression. Results
At time of TAVI, females were 1.48 years older (82.1 vs 83.5, P <0.001), had worse renal function, (CrCl 54.8±27.3 mL/min vs 50.3±21.2 mL/min, P=0.003), higher frailty scores (4.51±1.36 vs 5.03 ±1.32 P <0.001), and higher aortic gradients, (44.0±16.47 vs 48.34±15.91 mmHg, P <0.001). Men were more likely to have atrial fibrillation (29.7% vs 23.2%, P=0.018), left main stem coronary disease (7.5% vs 1.6%, P<0.001) and severely impaired left ventricular function (40.2% vs 24.3%, P<0.001) Peri-procedural outcomes were similar between groups, however, females received smaller valves (29.2±2.85 mm vs 26.8±2.37 mm, P<0.001) and experienced more vascular complications (5.4% vs 10.0%, OR 1.84, P=0.014). Rates of death (3.0% vs 1.8%, OR 0.839, p=0.71) and MACE (5.9% vs 4.3%, OR 0.86, p=0.63) to discharge did not differ between groups. Post-TAVI median survival was more than one year longer in females (1350 vs 1728 days, p=0.018). Cox-Regression showed independent risk factors for reduced survival included biological sex (p<0.001), creatinine clearance (p<0.001), pulmonary disease (p<0.001), AF (p<0.001), frailty (p=0.04) and poor mobility (p=0.03). Categorical data presented as (male % vs female %). Continuous as (male±standard deviation vs female ±standard deviation). Odds ratios adjusted. Conclusion
In keeping with previously documented concerns of inequality of access to TAVI by sex, Female patients were older, frailer and had higher aortic gradients than males. No differences were found between sexes in mortality or MACE to discharge despite females experiencing more peri-procedural vascular injury. Within our cohort, females had significantly increased long-term survival compared to males. Conflict of Interest
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