Women undergoing transcatheter aortic valve implantation (TAVI) experienced higher rates of procedural complications but lower long-term mortality than men. A retrospective population-based cohort study published in JAMA Cardiology analyzed fee-for-service Medicare beneficiaries discharged after TAVI between January 1, 2013, and December 31, 2022. 

Patients undergoing concomitant valve surgery, valve-in-valve TAVI, transapical TAVI, TAVI for isolated aortic insufficiency, infective endocarditis, or later conversion to Medicare Advantage were excluded. The analysis included 314,123 patients, comprising 141,233 women (45.0%) and 172,890 men (55.0%), with a median follow-up of 2.19 years. 

Women undergoing TAVI were older than men, with a mean age of 80.3 ± 7.8 years versus 79.4 ± 7.7 years. Female representation among TAVI recipients declined from 47.6% in 2013 to 43.6% in 2022 (P<0.001). Compared with men, women experienced higher rates of periprocedural mortality (2.5% vs 2.2%; adjusted odds ratio [AOR] 1.20, 95% confidence interval [CI] 1.14-1.26), vascular complications (5.8% vs 3.6%; AOR 1.65, 95% CI 1.60-1.71), and major or life-threatening bleeding (10.4% vs 6.8%; AOR 1.67, 95% CI 1.62-1.71).

However, permanent pacemaker implantation occurred less frequently in women than men (16.9% vs 20.0%; AOR 0.81, 95% CI 0.79-0.82). Despite higher procedural complication rates, women had lower long-term all-cause mortality following TAVI (adjusted hazard ratio [AHR] 0.92, 95% CI 0.91-0.93). Risks of heart failure hospitalization, acute myocardial infarction, stroke, and bleeding remained higher among women during follow-up.

These findings suggest persistent sex-based differences in procedural and long-term outcomes after TAVI among Medicare beneficiaries.