Sex influences risks after heart valve procedure

A study by Karl Landsteiner University of Health Sciences (klu Krems) has revealed significant differences in the prognosis for men and women after transcatheter aortic valve replacement (TAVI), particularly concerning the need for a pacemaker. The findings, based on data from over 1,100 patients, highlight the need for a more individualized risk assessment.

TAVI, a procedure where a new heart valve is inserted via a catheter, has transformed the treatment of severe aortic valve stenosis without requiring open-heart surgery. However, a common consequence of the procedure is disruption of the heart's electrical conduction system, potentially necessitating a permanent pacemaker. Previously, these risks were often examined collectively for both sexes, despite notable anatomical and health differences.

"Our results show that pacemaker status does not carry the same prognostic significance for women and men," stated Dr. Cecilia Veraar, the study's lead author. "In women, we observe an increased risk of complications shortly after receiving a new pacemaker, while in men, a pre-existing pacemaker might indicate a long-term risk."

The research analyzed data from 1,114 patients who underwent TAVI between 2016 and 2020. Both short-term (30-day) and long-term (five-year) mortality were examined separately by sex. Notably, men were more likely to have a pacemaker prior to TAVI than women. While both sexes required a new pacemaker after the procedure with similar frequency, differences in outcomes emerged.

For women, a new pacemaker was associated with poorer 30-day survival and a higher incidence of bleeding. However, at five-year follow-up, pacemaker status ceased to be a significant factor for survival. For men, the pattern was reversed: no short-term differences were observed, but a pre-existing pacemaker before TAVI was linked to a worse long-term prognosis. The study suggests that sex-specific factors should be more integrated into risk assessment and care, especially as TAVI is increasingly performed on younger patient populations.