Left ventricular function determines the survival benefit for women over men after transcatheter aortic valve implantation (TAVI)

Aims: There is evidence for a lower mortality in female patients after transcatheter aortic valve implantation (TAVI), but the underlying reasons for the gender-specific differences in prognosis are not well understood. In particular, the role of left ventricular dysfunction is unclear. In this study, we addressed the question of whether differences in left ventricular ejection fraction (LVEF) could account for the gender benefit for female TAVI patients. Methods and results: From January 2011 to December 2013, a total of 15,616 patients treated with TAVI were prospectively enrolled in the German Aortic Valve Registry (GARY). For the present analysis, female TAVI patients (N=8,456) were compared with male TAVI patients (N=7,160) with a particular focus on LVEF. Mortality at one year was 18.1% in women and 22.6% in men (p<0.001). Multivariate analysis also revealed that female gender was associated with a lower one-year mortality (adjusted hazard ratio [HR] 0.88 [0.81-0.95]). There was no difference in gender-specific mortality in patients with baseline LVEF >50% (women: 16.4%; men 17.6%, p=0.268), but in patients with LVEF 30%-50% (21.0% versus 25.7%, p<0.001) and <30% (26.2% versus 37.6%, p<0.001) one-year mortality was significantly lower in women than in men. Conclusions: The survival benefit for women over men after TAVI was only observed in patients with a preprocedural LVEF ≤50%.