Gender Differences of CT Measurements in Patients Undergoing Transcatheter Aortic Valve Implantation: Influence on Long-Term Clinical Outcomes

Objectives: To evaluate gender-specific differences in computed tomography (CT) measurements and outcomes in patients with severe aortic stenosis (AS) referred for transcatheter aortic valve implantation (TAVI).

Background: Very little data exist on the impact of gender on CT measurements and their influence on outcomes in patients referred for TAVI.

Methods: In our cohort of 506 patients (263 women and 243 men) we assessed the impact of gender on aortic root dimensions: annulus cross-sectional area (CSA), perimeter (Perim), Sino-tubular junction (STJ), sinus of Valsalva (SOV), and distance of left and right coronary artery ostia from the aortic annulus plane. In addition, we assessed the impact of gender on subclavian arteries, ascending aorta, abdominal aorta, and iliofemoral arteries.

Results: Women had significantly smaller CSA (405 ± 75 vs. 512 ± 110 mm²), Perim (71.8 ± 7.5 vs. 80.6 ± 8.5 mm), STJ mean diameter, (26.3 ± 3.4 vs. 29.7 ± 4.0 mm), SOV mean diameter (31.8 ± 4.2 vs. 36.3 ± 3.8 mm), and lower left and right coronary artery ostia height (12.3 ± 2.4 vs. 14.0 ± 2.9 mm; 14.8 ± 2.6 vs. 17.0 ± 3.3 mm, respectively) versus men; P < 0.001 for all, even after adjustment of the small body surface area (BSA) in women. The dimensions of abdominal aorta and iliofemoral arteries were significantly smaller in women compared to men; after adjustment for BSA; however, men and women have comparable values. Women had a trend towards increased rate of major and minor vascular complications (25.5% vs. 22.6%; P = 0.4), but a lower rate of aortic regurgitation (42% vs. 51%; P = 0.06).

Conclusions: In this large AS population, lower rate of aortic regurgitation in women may be explained by small aortic root dimensions and the higher rate of vascular complications by small dimensions of iliofemoral arteries.