Introduction: Recent registry-based studies have suggested that women have comparable outcomes to men after TAVR. We aimed to investigate this further by evaluating procedural use and outcomes among patients undergoing surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) from a large inpatient dataset in the United States.
Methods: Retrospective analysis of longitudinal nationwide hospital data from the Nationwide Inpatient Sample was used to identify patients who underwent TAVR or SAVR in 2013. Descriptive analysis was used to examine differences in patient characteristics, and multivariate, hierarchical logistic regression was performed to determine the association of gender with in-hospital mortality and pacemaker requirement after TAVR, with adjustment for age, comorbidities, payor type, income quartile, and race.
Results: Women constituted 50% of admissions coded with aortic valve disease as the diagnosis. Women received 48% of the 2705 TAVRs performed and 35% of the 14,921 SAVRs performed. Women who received TAVR were older (82 +/- 8 years for women vs. 81 +/-9 years for men, p<0.0001), but with lower Charlson comorbidity scores (2.5 for women vs. 2.9 for men, p<0.0001). Despite a lower burden of comorbidities, women suffered higher in-hospital mortality after TAVR (5.6% among women vs. 4.0% among men, p=0.05), and this effect size increased with adjustment for patient characteristics (OR=1.64 [CI 1.10-2.44], p=0.02). Women also had a longer TAVR hospital length of stay (9.2 +/- 7 days among women vs. 8.4 +/- 8 days among men, p=0.008). Women had no difference in permanent pacemaker requirement after TAVR, both before adjustment (9.3% among women vs. 9.9% among men, p=0.62) and after adjustment (OR=1.12 [0.93-1.36], (p=0.23).
Conclusion: TAVR is more frequently chosen over SAVR as a treatment option for women with aortic valve disease despite their lower burden of comorbidities. However, women who received TAVR had worse in-hospital mortality than men. Further studies to determine causes of these sex differences should be pursued to elucidate how TAVR outcomes for women can be improved in the early post-procedure period.