HEART VALVE DISEASES
P1 SEX AND GENDER DIFFERENCES IN TAVI PATIENTS: FROM CLINICAL PRESENTATION TO PROCEDURAL OUTCOMES

The epidemiological impact of aortic stenosis has recently grown, and indications to valvular treatment have changed substantially with the implementation in clinical practice of TAVI procedures. Significant differences according to patients’ sex are likely to be related to different biological features, but the undelrying mechanisms haven’t been verified yet.

We collected from the SwissTAVI Registry the available data about 373 subjects who where consecutively treated in Cardiocentro Ticino with a TAVI procedure over the last 10 years. We compared two subgroups of female (n = 161, age 83.5±5.4 yrs) and male (n = 212, age 82.3±5.9 yrs) patients in terms of severity indices of the disease (residual valve area and transvalvular gradients). The same parameters were measured after the procedure with a quantitative estimation of eventual post-procedural paravalvular leaks.

As previously reported, female patients showed significantly higher transvalvular mean gradients at baseline (48.02±16.0 vs. 42.9±14.8 mmHg; P = 0.004) on smaller resudual valve areas (0.66±0.18 vs. 0.77±0.19 cm²; P < 0.001). TAVI procedures were equally efficient in both sex, restoring similar valve areas and gradients, but paravalvular leaks were more frequent and significant in females (F vs. M no leak 44.5 vs. 55.3%, mild 47.7 vs. 42.7%, moderate 6.5 vs. 1.5%, severe 1.3 vs. 0.5%; overall P = 0.037).

Sex-related differences are only partially described and their substrate is not clear. Female patients are known to be more prone to bleedings and cerebrovascular accidents, but our data show that also paravalvular leaks could be more common and significant in comparison to males. A detailed analysis of the anatomy of the aortic outflow and of the valvular deterioration in aortic stenosis is required and is the aim of the second phase of this study. Understanding sex-related characteristics underlying these discrepancies can potentially improve TAVI technologies towards a further customization of prosthetic devices.