Sex differences in postprocedural aortic regurgitation and mid-term mortality after transcatheter aortic valve implantation

Background The impact of female sex on mortality after transcatheter aortic valve implantation (TAVI) is controversial. Post-procedural aortic regurgitation (AR)≥2 has been associated with poor outcomes. Whether sex differences in post-procedural AR≥2 could contribute to a mortality difference between women and men is not known. Methods Six hundred fifty-six patients, women (53.1%), men (46.9%), with aortic stenosis underwent TAVI with the CoreValve system (92.8%) or the Edwards SAPIEN valve system (7.2%). AR was graded semiquantitatively as 0=none, 1=trivial, 2=mild, 3=moderate, and 4=severe. The incidence of post-procedural AR≥2 was reported. Results Procedural success was similar in women as compared to men (97.9 vs 96.7%, P=0.32). Post-procedural AR≥2 occurred less frequently in women than in men (20.9 vs 29.6%, P=0.01). After a median follow-up of 434 days, all-cause mortality tended to be lower in women than in men (20.7 vs 26.6%, logrank P=0.10), and was significantly higher in patients with AR≥2 than in those without (34.8 vs 19.7%, logrank P<0.001). AR≥2 [hazard ratio (HR) 1.73, 95% confidence interval (CI) 1.22-2.43, P=0.002], but not female sex (P=0.17) was an independent predictor of all-cause death at multivariable Cox regression. The predictive value of AR≥2 was restricted to men (HR 2.96, P<0.001 among men; HR 0.86, P=0.60 among women; P for interaction=0.002). Conclusions Women, as compared to men, present a trend toward lower mortality. A significant lower incidence of post-procedural AR≥2 among women contributes to this finding. Female sex, however, was not a significant independent predictor of death. © 2014 Wiley Periodicals, Inc. © 2014 Wiley Periodicals, Inc.