Women more likely to undergo TAVR, at higher risk of in-hospital death

Use of transcatheter aortic valve replacement (TAVR) is still not common among young patients, being restricted only to those at increased risk, reports a study in France. Significant differences in sex appear in patient demographics, selection of aortic valve replacement (AVR) modality, and patient outcomes.

A nationwide administrative database was used to assess age- and sex-related trends in TAVR uptake, patient demographics, and in-hospital outcomes between 2015 and 2020.

Overall, 107,397 patients (44.0 percent female) underwent an AVR (59.1 percent TAVR and 40.9 percent SAVR). In patients aged <65 years, TAVR proportion rose by 63.2 percent (p<0.001) from 2015 to 2020 but remained uncommon at 11.1 percent of all AVR by 2020. Of note, TAVR was the more common modality in patients aged ≥65 years.

In patients who underwent TAVR, the Charlson comorbidity index (CCI; p=0.119 for trend) and in-hospital mortality (p=0.740 for trend) did not change in patients aged <65 years but decreased in those aged ≥65 years regardless of sex (p<0.001 for all).

Notably, female patients were older (p<0.001), had lower CCI (p<0.001), had higher odds of undergoing TAVR (p<0.001), and had higher in-hospital mortality (TAVR: p=0.015; SAVR: p<0.001). These findings persisted after adjusting for age and CCI.

“Additional research evaluating the long-term impact of TAVR use in young patients and prospective data evaluating sex differences in AVR modality selection and outcomes are needed,” the authors said.

“Current guidelines recommend selecting surgical aortic valve replacement (SAVR) or TAVR based on age, comorbidities, and surgical risk,” they noted.