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. 2022 Aug 22;15(16):1652-1660.
doi: 10.1016/j.jcin.2022.06.036.

Sex Difference in Outcomes Following Transcatheter Aortic Valve Replacement in Bicuspid Aortic Stenosis

Jing-Jing He  1 , Tian-Yuan Xiong  1 , Yi-Jun Yao  1 , Yong Peng  1 , Jia-Fu Wei  1 , Sen He  1 , Yong Chen  1 , Qiao Li  1 , Zhen-Gang Zhao  1 , Xin Wei  2 , Wen-Xia Zhou  2 , Yu-Jia Liang  2 , Hong Tang  2 , Guo Chen  3 , Xuan Zhou  4 , Ming-Xia Zheng  1 , Wei Meng  5 , Yan-Biao Liao  1 , Yi-Jian Li  1 , Yi-Ming Li  1 , Fei Chen  1 , Yuan-Weixiang Ou  1 , Qi Liu  1 , Xi Li  1 , Xi Wang  1 , Yi Zhang  1 , Zhong-Kai Zhu  1 , Hao-Ran Yang  1 , Kai-Yu Jia  1 , Mao Chen  6 , Yuan Feng  7
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Free article

Sex Difference in Outcomes Following Transcatheter Aortic Valve Replacement in Bicuspid Aortic Stenosis

Jing-Jing He et al. JACC Cardiovasc Interv. .
Free article

Abstract

Background: It is unknown whether the sex difference whereby female transcatheter aortic valve replacement (TAVR) candidates had a lower risk profile, a higher incidence of in-hospital complications, but more favorable short- and long-term survival observed in tricuspid cohorts undergoing TAVR would persist in patients with bicuspid aortic valves (BAVs).

Objectives: The aim of this study was to reexamine the impact of sex on outcomes following TAVR in patients with BAVs.

Methods: In this single-center study, patients with BAVs undergoing TAVR for severe aortic stenosis from 2012 to 2021 were retrospectively included. Baseline characteristics, aortic root anatomy, and in-hospital and 1-year valve hemodynamic status and survival were compared between sexes.

Results: A total of 510 patients with BAVs were included. At baseline, women presented with fewer comorbidities. Men had a greater proportion of Sievers type 1 BAV, higher calcium volumes (549.2 ± 408.4 mm3 vs 920.8 ± 654.3 mm3; P < 0.001), and larger aortic root structures. Women experienced more vascular complications (12.9% vs 4.9%; P = 0.002) and bleeding (11.1% vs 5.3%; P = 0.019) and higher residual gradients (16.9 ± 7.7 mm Hg vs 13.2 ± 6.4 mm Hg; P < 0.001), while men were more likely to undergo second valve implantations during index TAVR (6.3% vs 15.9%; P = 0.001). Death at 1 year was not significantly different between sexes (HR: 1.15; 95% CI: 0.56-2.35; P = 0.70). Bleeding (adjusted HR: 4.62; 95% CI: 1.51-14.12; P = 0.007) was the single independent predictor of 1-year death for women.

Conclusions: In patients with BAVs undergoing TAVR, women presented with fewer comorbidities, while men had a greater proportion of type 1 BAV, more calcification, and larger aortic roots. In-hospital outcomes favored men, with fewer complications except for the need for second valve implantation, but 1-year survival was comparable between sexes.

Keywords: bicuspid aortic valve; sex difference; transcatheter aortic valve replacement.

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Conflict of interest statement

Funding Support and Author Disclosures This work was supported by the National Natural Science Foundation of China (grants 81970325, 82170375, and 82102129); Sichuan Province Department of Science and Technology (grant number 2022YFS0364); West China Hospital “1·3·5” Discipline of Excellence Project “Percutaneous Transcatheter Aortic Valve Implantation” and “Mechanisms of Aortic Stenosis and the Clinical Applications”; and a fellowship of the China Postdoctoral Science Foundation (2020M683327). Drs Mao Chen and Feng are proctors and consultants for Venus MedTech, MicroPort, and Peijia Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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