Sex difference in characteristics and outcomes for transcatheter aortic valve implantation: a nationwide japanese study

Abstract Introduction Although the impact of gender differences on cardiac surgery for aortic stenosis (AS) is well known, the impact of gender differences on in-hospital complications has not been thoroughly investigated in the field of Transcatheter aortic valve implantation (TAVI) using a national database. Purpose To clarify the impact of gender differences on clinical outcomes by comparing women and men undergoing TAVI. Introduction Although the impact of gender differences on cardiac surgery for aortic stenosis (AS) is well known, the impact of gender differences on in-hospital complications has not been thoroughly investigated in the field of Transcatheter aortic valve implantation (TAVI) using a national database. Methods The current study was an observational retrospective study using Japanese nationwide data from the Japanese Registry Of All cardiac and vascular Diseases-Diagnostic Procedure Combination (JROAD-DPC) from April 1, 2013, to March 31, 2022. We examined differences in baseline patient characteristics, in-hospital mortality, and outcomes during hospitalization. Result During the period, 66% of patients who underwent TAVI were women (women=23,978 and men=12,375). Women were older (mean age: 84.9 years vs. 83.5 years, p0.001) and had smaller body surface area (BSA) (mean BSA: 1.36 m² vs. 1.59 m², p0.001). In addition, women were more likely to have hypertension (59.0% vs. 55.7%, p0.001) and implanted self-expandable valves (28.2% vs. 24.7%, p0.001). On the other hand, women had less comorbidities such as diabetes (21.8% vs. 29.4%, p0.001), renal disease (9.1% vs. 14.5%, p0.001), and peripheral vascular disease (5.9% vs. 7.9%, p0.001). Women had similar rates of in-hospital mortality (1.2% vs. 1.3%, p=0.37), ischemic stroke (2.3% vs. 2.4%, p=0.59), and hemorrhagic stroke (0.1% vs. 0.1%, p=0.94) compared to men. However, women had a higher frequency of red cell concentrate transfusion (RCC) (43.5% vs. 30.3%, p0.001) and a higher incidence of major bleeding (10.1% vs. 8.7%, p0.001) than men. Furthermore, women had a higher incidence of permanent pacemaker implantation (7.1% vs. 5.9%, p0.001). Of note, the pacemaker implantation rate was comparable among self-expandable valves (10.0%, 10.1%, p=0.91); on the other hand, in the case of balloon-expandable valves, the pacemaker implantation rate was higher in women than in men (6.0% vs. 4.5%, p0.001) (Figure1). The pacemaker implantation rate has decreased annually in both women and men (Figure2). Conclusion The JROAD-DPC data showed that TAVI for AS was performed twice as often in women as in men in the real world. Women with a significantly small BSA had a higher prevalence of hypertension compared to men but had fewer other comorbidities. There were no significant sex differences in mortality and stroke; however, the rate of RCC transfusion and permanent pacemaker implantation were higher in women.Figure1 Figure2