TAVR has become the first line therapy for aortic stenosis in elderly population. Anatomic and biometric differences between female and male patients may impact outcome.

We aimed to compare gender-specific rates of major peri-procedural complications as well as 30-days and 1-year mortality rates after transfemoral TAVR.

A retrospective analysis of a prospective cohort of patients undergoing TAVR at a tertiary university center and participating to the national TAVR cohort was performed to assess outcomes in female versus male patients and associated factors. The primary endpoint was peri-procedural composite of death, stroke, myocardial infarction (MI), vascular surgery and tamponade. Other endpoints included individual components of the primary endpoint, 30-days and 1 year mortality. Event rates were compared between gender groups by a Chi-squared test and a logistic regression model adjusted on age, gender, STS score and valve size as well as all baseline variables differently distributed between groups ( P < 0.1).

In all, 1369 consecutive patients were enrolled, 48% were female patients. All baseline characteristics were similarly distributed between female and male groups with the exception of age (83 ± 7 vs 81 ± 8, P < 0.0001), history of coronary artery disease (38 vs 50%, P < 0.0001), STS score (6.4 ± 3.4 vs 5.2 ± 3.2, P < 0.0001), smaller aortic annulus surface (378 ± 66 vs 481 ± 71, P < 0.0001) and the subsequent small-size prosthetic valve rates (78% vs 21%, P < 0.0001) respectively. As summerized in table 1 Figure 1 , rates of the primary endpoint were higher in the female group (7.8 vs 3.4%, P = 0.0004). After adjustment, female gender was significantly associated with higher rates of the primary endpoint with (OR 2.41, [95% CI: 1.47–3.99]; P = 0.0006). The only other independent correlate of the primary endpoint was the presence of peripheral artery disease ( P < 0.05). Mortality rates at 30 days and 1 year were not different between groups. Independent correlates of 1 year mortality were body mass index ( P < 0.05) and creatinine clearance ( P < 0.0001). Annulus measurements, valve size or type were not significantly associated to any event.

Our study indicates that female gender poses higher peri-TAVR complication risks, independent of anatomical and biometric differences especially annulus/valve size. While mortality rates are similar between genders, enhancing per-procedural management for female TAVR patients is crucial.