Following transfemoral transcatheter aortic valve replacement (TAVR), women and men have similar rates of 30-day mortality and stroke, but women have a 50 percent greater risk of life-threatening or major bleeding, according to results of an analysis presented Sept. 25 at TCT 2019 and simultaneously published in the Journal of the American College of Cardiology.

Wieneke Vlastra, MD, et al., used a global patient-level dataset from the CENTER collaboration, examining 12,381 patients (7,120 women; 58 percent) undergoing transfemoral TAVR from 2007 to 2018. Researchers examined differences between women and men in baseline patient characteristics, 30-day stroke and mortality, and in-hospital outcomes. They also assessed temporal changes in outcomes and predictors for mortality by sex.

The retrospective analysis showed that women compared with men had a higher prevalence of hypertension (81 percent vs. 76 percent) and renal failure (14 percent vs. 11 percent) but a lower prevalence of all other traditional cardiovascular comorbidities (33 percent vs. 51 percent). Both women and men had similar rates of 30-day stroke (2.3 percent vs. 2.5 percent) and all-cause mortality (5.9 percent vs. 5.5 percent).

The risk of life-threatening or major bleeding was 6.7 percent in women compared with 4.4 percent in men (p<0.001) after TAVR. An inverse relationship between body mass index and the risk of bleeding was found in women, but not in men, with a risk of 7.7 percent in the lowest tertile and 5.5 percent in the highest tertile.

"The current study does not support the hypothesis that female gender is a risk factor for TAVR-related mortality," wrote the researchers. "Females had [a] 50 percent higher risk of life-threatening or major bleeding." They note that one of the most important risk factors for bleeding is a large sheath-to-femoral artery ratio, accordingly the smaller iliofemoral arteries and vascular tortuosity in females most likely contribute to the increased risk of vascular complications and consequently bleeding. "Bleeding risk was more pronounced in females with low BMI [and] we hypothesize [that] smaller females have smaller vessels than larger females and consequently have a higher risk of vascular complications and bleedings."

Keywords: TCT19, Transcatheter Cardiovascular Therapeutics, Angiography

< Back to Listings