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Review
. 2025 May 30;9(7):100666.
doi: 10.1016/j.shj.2025.100666. eCollection 2025 Jul.

Understanding Aortic Stenosis and Transcatheter Aortic Valve Replacement in Women

Giulia Masiero  1 , Anna Franzone  2 , Valeria Paradies  3 , Nicole Karam  4   5 , Chiara Fraccaro  1 , Chiara De Biase  6 , Mirvat Alasnag  7 , Giulia Botti  8 , Angelicarosa Cascone  8 , Ana Belen Cid-Alvarez  9 , Tanja K Rudolph  10 , Marta Kaluzna-Oleksy  11 , Stephane Manzo-Silberman  12 , Julinda Mehilli  13   14 , Barbara E Stähli  15 , Julia Grapsa  16 , Kyriakos Panaou  17 , Barbara Bellini  18 , Joanna J Wykrzykowska  17 , Sabine Bleiziffer  19 , Helene Eltchaninoff  20 , Martine Gilard  21 , Alaide Chieffo  8   19
Affiliations
Review

Understanding Aortic Stenosis and Transcatheter Aortic Valve Replacement in Women

Giulia Masiero et al. Struct Heart. .

Abstract

The impact of sex on the baseline characteristics, morphology, and clinical presentation of degenerative aortic stenosis (AS) is well-documented but remains poorly understood. Unlike valve surgery, for which patients have been predominantly male, percutaneous treatment of AS has shown balanced representation of both sexes, with women demonstrating greater benefit from transfemoral aortic valve replacement compared to surgical treatment. This review explores sex-specific differences in the epidemiology, pathophysiology, diagnostic challenges, treatment approaches, and clinical outcomes of degenerative AS. Furthermore, it addresses technical, sex-specific considerations in transfemoral aortic valve replacement, including preprocedural screening, device selection, implantation strategy, and postprocedural management.

Keywords: Aortic stenosis; Clinical management; Device selection; Sex differences; Transcatheter aortic valve implantation.

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Conflict of interest statement

The authors report no conflict of interest.

Figures

Figure 1
Figure 1
Illustrative representation of different aortic valve phenotypes in men and women according to diagnostic modalities. Abbreviations: AS, aortic stenosis; cMR, cardiac magnetic resonance; LF-LG AS, low-flow low-gradient aortic stenosis; LV, left ventricle; MDCT, multidetector computed tomography; TTE, transthoracic echocardiography.
Figure 2
Figure 2
Illustrative representation of different clinical presentation of significant aortic stenosis in men and women. ∗Frailty in Older Adults Undergoing Aortic Valve Replacement Index. Abbreviation: HF, heart failure.
Figure 3
Figure 3
TAVR outcomes in women vs. men: summary of evidence. Abbreviation: TAVR, transcatheter aortic valve replacement.
Figure 4
Figure 4
Periprocedural considerations for TAVR procedure in female patients: an integrative approach. Abbreviations: LFLG AS, low-flow low-gradient aortic stenosis; LV, left ventricle; PPM, patient-prosthesis mismatch; SFAR, sheath-to-femoral artery ratio; TAVR, transcatheter aortic valve replacement; THV, transcatheter heart valve.
See this image and copyright information in PMC

References

    1. Stehli J., Zaman S., Stähli B.E. Sex discrepancies in pathophysiology, presentation, treatment, and outcomes of severe aortic stenosis. Front Cardiovasc Med. 2023;10 doi: 10.3389/fcvm.2023.1256970. - DOI - PMC - PubMed
    1. Masiero G., Paradies V., Franzone A., et al. Sex-specific considerations in degenerative aortic stenosis for female-tailored transfemoral aortic valve implantation management. J Am Heart Assoc. 2022;11(19) doi: 10.1161/JAHA.121.025944. - DOI - PMC - PubMed
    1. Calabrò P., Niccoli G., Gragnano F., et al. Are we ready for a gender-specific approach in interventional cardiology? Int J Cardiol. 2019;286:226–233. doi: 10.1016/j.ijcard.2018.11.022. - DOI - PubMed
    1. Stewart B.F., Siscovick D., Lind B.K., et al. Clinical factors associated with calcific aortic valve disease. Cardiovascular Health Study. J Am Coll Cardiol. 1997;29(3):630–634. doi: 10.1016/s0735-1097(96)00563-3. - DOI - PubMed
    1. Freman R.V., Otto C.M. Spectrum of calcific aortic valve disease: pathogenesis, disease progression, and treatment strategies. Circulation. 2005;111(24):3316–3326. doi: 10.1161/CIRCULATIONAHA.104.486738. - DOI - PubMed

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