Clinical Outcomes of TAVI or SAVR in Men and Women with Aortic Stenosis at Intermediate Operative Risk: a post hoc analysis of the randomized SURTAVI trial.

AIMS In patients with aortic stenosis randomized to transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR), sex-specific differences in complication rates are unclear in intermediate-risk patients. METHODS AND RESULTS 1,660 intermediate-risk patients underwent TAVI with a supra-annular, self-expanding bioprosthesis or SAVR. The population was stratified by sex and treatment modality (female TAVI=366, male TAVI=498, female SAVR=358, male SAVR=438). The primary endpoint was a composite of all-cause mortality or disabling stroke at two years. Compared to males, females had a smaller body surface area, a higher Society of Thoracic Surgeons score (4.7±1.6% vs. 4.3±1.6%, p<0.01) and more frailty. Men required more concomitant revascularization (23% vs. 16%). All-cause mortality or disabling stroke at two years was similar between TAVI and SAVR for females (10.2% vs. 10.5%, p=0.90) and males (14.5% vs. 14.4%, p=0.99); the difference between females and males was 10.2% vs. 14.5%, for TAVI (p=0.08) and 10.5% vs. 14.4%, SAVR (p=0.13). Functional status improvement was more pronounced after TAVI for females than males. CONCLUSIONS Aortic valve replacement, either by surgical or transcatheter approach, appears similarly effective and safe for males and females at intermediate surgical risk. Functional status appears to improve most in females after TAVI.