TAVR in Bicuspid Patients: Are Outcomes the Same in Men and Women?

Bicuspid aortic valve stenosis (BAV) has not yet been analyzed in large, randomized studies, and TAVR in this scenario has been assessed only by small fairly studies. However, the information available is quite promising.

TAVR in women generally presents more complications than in men, but severe bicuspid aortic valve stenosis receiving TAVR has not been well looked at.

This study included 510 patients from one singe center. 225 women (44.1%) and 285 men.

The valve most used was Venus-A Valve (Venus Medtech).

Mean age was 72; men presented more comorbidities, such as kidney failure, COPD and prior heart disease and PCI, in addition to lower left ventricular ejection fraction and more aortic failure associated to stenosis.

On the other hand, women presented higher aortic velocity and less ascending aortic dilation.

STS was similar: 5.6±3.8% for women and 4.9±4.2 for men (P=0.066).

CT showed type 0 BAV was the most frequent in women and Type I in men. The latter presented more calcification, with larger aortic annuli, valve area and aortic root size.

During the procedure, the need for a second valve was greater in men. However, there were more vascular complications in women.

At hospital level, there were no differences in mortality or stroke, neither in need for pacemaker implantation (women 17.1% vs. 22.5% p=0.1).

At 30 days and one year, there were no differences in mortality.

Eco-Doppler were analyzed at 30 days and one year. Women presented higher gradient but fewer major to mild paravalvular leaks without reaching statistical value. Both groups improved ejection fraction and presented reduced ventricular mass.

At multivariable analysis, bleeding was a mortality predictor in women while creatinine level and aortic root diameter >45 mm were predictors in men.

Conclusion

In patients with bicuspid aortic valves receiving TAVR, women presented fewer comorbidities, while men more often presented type I BAV, more calcification and larger aortic roots. At hospital level, men presented better evolution, fewer complications but more need of a second valve. Survival at one year was similar between sexes.