Sex differences in population versus in-hospital use of aortic valve replacement procedures in Spain

It is not well known if sex differences in the use and results of aortic valve replacement (AVR) are changing. The aim of the study is to assess the time trends in the differences by sex in the utilization of AVR procedures in hospitals and in the community.

Retrospective observational analysis using data from the Spanish National Hospitalizations Administrative Database. All hospitalizations between 2016 and 2021 with a main diagnosis of aortic stenosis (International Classification of Diseases-10 codes: I35.0 and I35.2) were included. Time trends in hospitalization, AVRs, and hospital outcomes were analysed. Crude utilization and population-standardized rates were calculated. During the study period, 64 384 hospitalizations in 55 983 patients (55.5% men) with 36 915 (65.9%) AVR were recorded. Of these, 15 563 (42.2%) were transcatheters and 21 432 (58.0%) were surgical. At the hospital level, transcatheter procedures were more frequently performed in women (32.3% vs. 24.2%, P < 0.001), and surgical in men (42.9% vs. 32.5%, P < 0.001) but at the population level, surgical and transcatheter aortic valve replacements (TAVRs) were used more frequently in men (12.6 surgical and 8.0 transcatheter per 100 000 population) vs. women (6.4 and 5.8, respectively; P < 0.001 for both comparisons). Transcatheter procedures shifted from 17.3% in 2016 to 38.0% in 2021, overtaking surgical procedures in 2018 for women and 2021 for men.

TAVR has displaced surgical aortic valve replacement (SAVR) as the most frequent AVR procedure in Spain by 2020. This occurred earlier in women, who, despite the greater weight of their age group in the older population, received fewer AVRs, both SAVR and TAVR.