TAVR in Women

Severe aortic stenosis (AS) in women shows distinct features, compared to men, with lower prevalence of heart disease, among other differences. However, women have been underrepresented by clinical trials in general, and especially in the beginnings of TAVR, when they were associated to higher incidence of vascular complications and mortality. 

At present, there is limited evidence on the best therapeutic strategy for this group — surgical or transcatheter aortic valve replacement (TAVR vs SVAR).

This was a pooled analysis of the RHEIA and PARTNER 3 trials, focused on women with severe AS receiving either TAVR or SAVR, including a total of 712 patients, 376 treated with TAVR. 

The analysis excluded patients with unicuspid or bicuspid AS, those with complex heart disease, and poor candidates for TAVR or SAVR.

The balloon expandable SAPIEN 3 or SAPIEN 3 ULTRA were used for TAVR.

The primary outcome for both studies was a composite of all-cause mortality, stroke or readmission at one-year followup. 

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The populations were well balanced: mean age 73, mortality STS 2.1%, EuroSCORE II 1.7%. The prevalence of atrial fibrillation was 7%, CAD 16%, prior stroke 4.5%, peripheral vascular disease 4.5%, COPD 4%, diabetes 25% and prior pacemaker 2.5%.

After one year, the primary outcome favored TAVR: 8.5% vs. 16.8% (absolute difference: 8.2%; CI 95%: 13.1% to 3.3%; p < 0.001). There were no significant differences in mortality or stroke, though there was higher readmission rate among SAVR patients: 5.4% vs. 11.9% (absolute difference: 6.5%; CI 95%: 10.7% to 2.3%; p = 0.002).

The need for definite pacemaker implantation was low in both groups, both at 30 days and one year. 

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TAVR was associated with higher incidence of bleeding, but lower incidence of atrial fibrillation. There were no significant differences as regards kidney failure. 

Conclusion

In women with severe symptomatic AS, TAVR significantly reduced the combined rate of all-cause mortality, stroke or readmission at one year, mainly driven by lower readmission rate, vs SAVR. 

Original Title: Aortic Valve Replacement in Women A Pooled Analysis of the RHEIA and PARTNER 3 Trials VOL. 18, NO. 12, 2025. 

Reference: Helene Eltchaninoff, et al. JACC Cardiovasc Interv. 2025;18:1540–1553.