Men are from mars, women are from venus: Factors responsible for gender differences in outcomes after surgical and trans-catheter aortic valve replacement

• Published in: Trends in cardiovascular medicine 2021-01, Vol.31 (1), p.34-46
• Main Authors: Goel, Harsh, Kumar, Ashish, Garg, Nadish, Mills, James D.
• Format: Article
• Language: English
• Subjects: Age; Aortic stenosis; Aortic valve; Aortic Valve - physiopathology; Aortic Valve - surgery; Aortic Valve Stenosis - mortality; Aortic Valve Stenosis - physiopathology; Aortic Valve Stenosis - surgery; Catheters; Chronic obstructive pulmonary disease; Clinical Decision-Making; FDA approval; Female; Females; Gender; Gender differences; Health Status Disparities; Heart failure; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - mortality; Humans; Male; Morbidity; Mortality; Outcomes; Population; Postoperative Complications - mortality; Prostheses; Recovery of Function; Risk Assessment; Risk Factors; Sex Characteristics; Sex differences; Sex Factors; Suffering; Surgical aortic valve replacement; Trans-catheter aortic valve replacement; Transcatheter Aortic Valve Replacement - adverse effects; Transcatheter Aortic Valve Replacement - mortality; Treatment Outcome
• ISSN: 1050-1738; 1873-2615
• DOI: 10.1016/j.tcm.2019.11.010

Females suffer higher operative (30-day) mortality than males after surgical aortic valve replacement (SAVR). In contrast, outcomes after trans-catheter aortic valve replacement (TAVR) seem to favor females, both in terms of procedural mortality, and more prominently, medium to long-term survival. With an ever-greater number of TAVR procedures being performed, an understanding of factors responsible for gender differences in outcomes after the two AVR modalities is critical for better patient selection. Current evidence suggests that this gender difference in outcomes after SAVR and TAVR stems from differences in baseline risk profiles, as well as inherent anatomic/physiological differences between genders. This review attempts to examine these clinical and physiological factors, with a goal of guiding better patient selection for each AVR modality, and to highlight areas that beg further investigation.