Although trans-catheter aortic valve impantation (TAVI) for severe aortic stenosis (AS) is
becoming an established technique, the impact of gender-related differences remains unclear. Two hundred twenty four consecutive patients undergoing TAVI were prospectively followed up in a tertiary medical center. The primary end point of the present study was all-cause mortality at 2 years of follow-up. Interaction-term analysis was employed to identify gender-specific predictors of mortality following TAVI. Fifty seven percent of study patients were women. Age was similar (82±7< years). Compared with men, women had a lower frequency of coronary artery disease (CAD) and a higher baseline left ventricular ejection fraction (LVEF). The cumulative probability of all-cause mortality was significantly lower among females (8.6%) as compared with males (26.8%; log-rank pvalue < 0.001). A lower baseline LVEF (<45%) was associated with a significant >4-fold (p=0.0019 and 0.048, respectively) increase in mortality risk among both males and females (p-value for gender-by LVEF interaction = 0.87). In contrast, the risk associated with the presence of prior CAD was shown to be gender-related. Thus, among women CAD was associated with a pronounced >14-fold increase mortality risk, whereas among males CAD was not associated with a significant mortality risk (p-value for gender-by LVEF interaction = 0.01). In conclusion, Our findings suggest that risk assessment prior to TAVI should consider gender-specific differences in survival and risk factors.
