Stroke risk after TAVR still higher for woman as ‘sex paradox’ lives on
The “sex paradox” for transcatheter aortic valve replacement (TAVR) is still in effect, according to a new analysis of more than 2,500 patients. The study, published in Interdisciplinary CardioVascular and Thoracic Surgery, aimed to provide an updated look at the sex-related differences between men and women who undergo TAVR for severe aortic stenosis.[1]
“Sex differences in outcomes after TAVR remain incompletely understood,” wrote first author Maroua Eid, MD, a cardiac surgery fellow with the University Hospital of Angers in France, and colleagues. “Earlier studies described a ‘sex paradox,’ with women experiencing more procedural complications, but similar or superior survival compared with men. However, most data derive from earlier device generations, and contemporary evidence is limited.”
To learn more about how these trends may have shifted with the implementation of new techniques and technologies, Eid et a. tracked data from 2,718 TAVR patients treated at a single high-volume facility in France. Weekly heart team meetings were held for each case to ensure optimal care decisions were made, including valve selection and access route.
All TAVR procedures were performed from 2012 to 2023. The mean follow-up times were 3.3 years for women and 2.8 years for men. Self-expandable TAVR valves were implanted in 30.1% of men and 36.3% of women. The remaining patients received balloon-expandable TAVR valves.
More than 49% of patients included in this study were women. While female patients were significantly older at the time of treatment, they had fewer comorbidities. Pre-TAVR echocardiography results showed that women presented with higher mean transvalvular gradients and smaller aortic valve areas than men.
Propensity score matching was used to capture the most accurate comparison possible. Overall, 30-day mortality rates were comparable for men and women. While 30-day mortality rates were comparable, the adjusted all-cause mortality rate after five years was significantly higher for men than women. The adjusted stroke rate, meanwhile, was nearly four times higher for women than men.
“Our findings suggest that female and male patients differ not only in baseline characteristics, but also in clinical outcomes, with risk stratification playing an important role in modulating these differences,” the authors wrote. “Despite a frequent labeling as higher surgical risk due to advanced age or frailty, female patients demonstrated favorable postprocedural survival when compared with men, particularly in the low- to intermediate-risk subgroups. Conversely, in high-risk categories, outcomes were more comparable between sexes, suggesting that the protective effect observed in women may be attenuated in advanced disease stages or in the presence of multiple comorbidities.”
The group also called for more research on this topic. The long-term goal, they wrote, is to refine patient selection strategies, optimize procedural techniques and improve TAVR outcomes for both sexes.
Click here to read the full study in Interdisciplinary CardioVascular and Thoracic Surgery, an official journal of the European Association for Cardio-Thoracic Surgery.
Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.