Gender gap observed in early TAVI era closing

The considerable survival advantage observed in female patients undergoing transcatheter aortic valve implantation (TAVI) during the procedure’s earlier years has diminished in the contemporary TAVI era, according to research out of Petah Tikva, Israel, meaning men and women are seeing similar outcomes post-procedure.

Half of patients undergoing TAVI across the world are men, corresponding author Osnat Itzhaki Ben Zadok, MD, MSc, and colleagues in the cardiology department at Rabin Medical Center in Petah Tikva, wrote in the American Journal of Cardiology this month. But there’s been a gap in outcomes between the sexes since TAVI’s conception—one that favors women.

“Several studies have shown that female patients have increased long-term survival following TAVI compared to male patients, yet more recent data show conflicting results, describing similar outcomes in females and males,” Zadok and her team said. “Defining and understanding these sex-related differences have important clinical implications for patients of both sexes undergoing TAVI.”

To gauge the current state of TAVI outcomes, the researchers retrospectively collected data from 2,529 patients—1,159 men and 1,370 women—with severe symptomatic aortic stenosis who underwent TAVI at one of four medical centers in Israel between January 2008 and June 2017. The population was categorized based on procedure dates for temporal analysis.

Zadok et al. found that in TAVI’s earlier years, between 2008 and 2012, rates of in-hospital aortic paravalvular leak, myocardial infarction, pacemaker implantation and stroke were higher among male patients than female ones, which was expected. Women who underwent TAVI in the same period had a 26 percent lower risk of death compared to their male counterparts, but that difference didn’t persist.

Between 2013 and 2016, there were no sex-related differences in mortality risk in patients undergoing TAVI. Rates of paravalvular leak, MI, stroke and pacemaker implantation also leveled out.

“The main finding of the current study is that the survival advantage post-TAVI in female versus male patients during the early TAVI years has diminished in the contemporary TAVI era,” the authors said. “Moreover, the majority of procedural and in-hospital complication rates decreased in male patients and became comparable between the sexes.”

The survival advantage seen in women earlier on has been attributed to differences in left ventricular modeling and lower comorbidity profiles in female patients, but Zadok and her colleagues said technology probably has a lot to do with the gender gap closing. With the advent of multi-detector computed tomography for annulus sizing, the creation of newer generation prosthesis valves and an emphasis on larger-sized valves, recent advances have actually favored men.

“The more favorable long-term prognosis that has been repeatedly described in female versus male patients in the early TAVI years has diminished over time with contemporary TAVI,” the authors said. “This might be attributed to current technological advances and improved valve sizing, with a more significant benefit in favor of male patients.”