TY - JOUR
T1 - Clinical outcomes in women and men with raphe-type bicuspid aortic valve stenosis undergoing transcatheter aortic valve replacement
AU - Gitto, Mauro
AU - Kim, Won Keun
AU - Buono, Andrea
AU - Fabris, Tommaso
AU - De Biase, Chiara
AU - Costa, Giuliano
AU - Montarello, Nicholas
AU - Leone, Pier Pasquale
AU - Scotti, Andrea
AU - Bellamoli, Michele
AU - Alfadhel, Mesfer
AU - Koren, Ofir
AU - Fezzi, Simone
AU - Bellini, Barbara
AU - Massussi, Mauro
AU - Costa, Giulia
AU - Fraccaro, Chiara
AU - Mazzapicchi, Alessandro
AU - Giacomin, Enrico
AU - Burzotta, Francesco
AU - Zito, Andrea
AU - Trani, Carlo
AU - Gorla, Riccardo
AU - Hug, Karsten
AU - Briguori, Carlo
AU - Tartaglia, Francesco
AU - Bettari, Luca
AU - Colucci, Michele
AU - Villa, Emmanuel
AU - Regazzoli, Damiano
AU - Benvenuto, Ciro Pollio
AU - Boiago, Mauro
AU - Calamita, Gianmaria
AU - Renker, Matthias
AU - Gomez, Mario Garcia
AU - Ielasi, Alfonso
AU - Landes, Uri
AU - Rheude, Tobias
AU - Joner, Michael
AU - Testa, Luca
AU - Santos, Ignacio Amat
AU - Saia, Francesco
AU - Favero, Luca
AU - Bai, Lin
AU - Chen, Mao
AU - Adamo, Marianna
AU - De Carlo, Marco
AU - Montorfano, Matteo
AU - Makkar, Raj R.
AU - Mylotte, Darren
AU - Blackman, Dan
AU - Barbanti, Marco
AU - De Backer, Ole
AU - Tchetche, Didier
AU - Tarantini, Giuseppe
AU - Latib, Azeem
AU - Maffeo, Diego
AU - Mangieri, Antonio
AU - Mehran, Roxana
N1 - Publisher Copyright:
© 2025 Elsevier B.V.
PY - 2025/12/15
Y1 - 2025/12/15
N2 - Background: There is paucity of data regarding sex-related differences among patients with bicuspid aortic valve (BAV) undergoing transcatheter aortic valve replacement (TAVR). Methods: The AD-HOC was an observational, retrospective, investigator-initiated registry enrolling consecutive patients with Sievers type 1 BAV stenosis who underwent TAVR at 24 international centers from 2016 to 2023. The primary endpoint was major adverse events (MAEs), including death, neurologic events and heart failure hospitalization. Results: Of 980 included patients, 364 (37 %) were women. As compared to men, women had lower prevalence of associated comorbidities, smaller aortic dimensions and lower calcific burden on the raphe. After propensity score adjustment, Valve Academic Research Consortium-3 (VARC-3) defined technical success (93.7 % vs. 95.8 %, adjusted odds ratio [adj. OR]: 0.37, 95 % confidence intervals [CI]: 0.17–0.81) and device success (83.5 % vs. 86.6 %, adj, OR: 0.61, 95 % CI: 0.38–0.98) were lower in women, who also had more major periprocedural bleedings. There were no sex-differences in 3-year MAEs (19.7 % in women vs. 25.6 % in men, adjusted hazard ratio [adj. HR]: 0.75, 95 % CI: 0.47–1.20). Predictors of MAEs in men included diabetes, chronic obstructive pulmonary disease and severe aortic valve calcifications. Conversely, in women, chronic kidney disease was an independent predictor of MAEs and hemodynamic valve performance and higher baseline mean aortic gradients had a protective effect. Conclusions: Women undergoing TAVR for raphe-type BAV stenosis had lower technical and device success, but similar long-term clinical outcomes compared to men. Prognostic determinants differed between sexes, including clinical comorbidities in men and poor hemodynamic valve performance in women.
AB - Background: There is paucity of data regarding sex-related differences among patients with bicuspid aortic valve (BAV) undergoing transcatheter aortic valve replacement (TAVR). Methods: The AD-HOC was an observational, retrospective, investigator-initiated registry enrolling consecutive patients with Sievers type 1 BAV stenosis who underwent TAVR at 24 international centers from 2016 to 2023. The primary endpoint was major adverse events (MAEs), including death, neurologic events and heart failure hospitalization. Results: Of 980 included patients, 364 (37 %) were women. As compared to men, women had lower prevalence of associated comorbidities, smaller aortic dimensions and lower calcific burden on the raphe. After propensity score adjustment, Valve Academic Research Consortium-3 (VARC-3) defined technical success (93.7 % vs. 95.8 %, adjusted odds ratio [adj. OR]: 0.37, 95 % confidence intervals [CI]: 0.17–0.81) and device success (83.5 % vs. 86.6 %, adj, OR: 0.61, 95 % CI: 0.38–0.98) were lower in women, who also had more major periprocedural bleedings. There were no sex-differences in 3-year MAEs (19.7 % in women vs. 25.6 % in men, adjusted hazard ratio [adj. HR]: 0.75, 95 % CI: 0.47–1.20). Predictors of MAEs in men included diabetes, chronic obstructive pulmonary disease and severe aortic valve calcifications. Conversely, in women, chronic kidney disease was an independent predictor of MAEs and hemodynamic valve performance and higher baseline mean aortic gradients had a protective effect. Conclusions: Women undergoing TAVR for raphe-type BAV stenosis had lower technical and device success, but similar long-term clinical outcomes compared to men. Prognostic determinants differed between sexes, including clinical comorbidities in men and poor hemodynamic valve performance in women.
KW - Bicuspid aortic valve
KW - Sievers type 1
KW - Transcatheter aortic valve replacement
KW - VARC-3
KW - Women
UR - https://www.scopus.com/pages/publications/105013647593
U2 - 10.1016/j.ijcard.2025.133792
DO - 10.1016/j.ijcard.2025.133792
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C2 - 40835061
AN - SCOPUS:105013647593
SN - 0167-5273
VL - 441
JO - International Journal of Cardiology
JF - International Journal of Cardiology
M1 - 133792
ER -
