TAVR in Women: Optimizing Transcatheter Aortic Valve Replacement for Female Patients

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• Gender Differences in TAVR
• Clinical Outcomes for Women
• Anatomical Considerations
• Hemodynamic Benefits
• Patient Selection and Recovery
• Full Transcript

Gender Differences in TAVR

Dr. Jeffrey Popma, MD, addresses important gender-specific considerations in transcatheter aortic valve replacement. The women versus men comparison has been significant in cardiovascular medicine for many years. Cardiac surgeons recognize that women, particularly smaller women, present unique challenges. Dr. Jeffrey Popma, MD, explains that anatomical differences significantly influence treatment approaches.

Clinical Outcomes for Women

Research shows women experience excellent outcomes with transcatheter aortic valve replacement. Dr. Jeffrey Popma, MD, references randomized trials of high-risk patients comparing TAVR versus surgical approaches. These studies demonstrated that women fared particularly well with transcatheter procedures compared to surgical aortic valve replacement. The research primarily involved frail patient populations, prompting ongoing studies for younger female cohorts.

Anatomical Considerations

Female patients typically have smaller aortic annulus dimensions and overall body build. Dr. Jeffrey Popma, MD, emphasizes that these anatomical differences necessitate careful valve sizing. Smaller valves are often required for female patients undergoing aortic valve procedures. The hemodynamic challenges of valve placement become more pronounced in smaller-framed individuals, particularly women weighing approximately 90 pounds.

Hemodynamic Benefits

TAVR provides superior hemodynamic performance compared to surgical alternatives. Dr. Jeffrey Popma, MD, highlights research published by Dr. Kim Skelding in the American Journal of Cardiology. This research demonstrates that transcatheter aortic valve replacement achieves better gradients than open surgical approaches. The ability to implant larger valves relative to annulus size reduces prosthesis-patient mismatch. These hemodynamic advantages contribute significantly to improved patient outcomes.

Patient Selection and Recovery

TAVR offers distinct advantages for appropriate female patient candidates. Dr. Jeffrey Popma, MD, explains that recovery time proves particularly challenging for women after surgical aortic valve replacement. For intermediate to high-risk female patients, TAVR represents not just an equivalent option but often the preferred treatment method. The procedure's minimally invasive nature combined with excellent hemodynamic results makes it ideal for frail female patients. Dr. Anton Titov, MD discusses how patients benefit from avoiding open-heart surgery while still receiving effective aortic valve treatment.

Full Transcript

Dr. Anton Titov, MD: Are there nuances in transcatheter aortic valve replacement for men and women? TAVI or TAVR procedures are different in women compared with male patients?

Dr. Jeffrey Popma, MD: The women versus men quandary has been around for a long time. Our cardiac surgeons have known that in women, particularly smaller women, there is a problem. Sometimes the aortic annulus and the body build is a little bit smaller than in men.

Sometimes smaller valves need to be used. We looked at this in our randomized trial of high-risk patients women versus men. We found that women did pretty well with transcatheter aortic valve replacement compared to surgical aortic valve replacement.

We think that was a frail population of patients. Maybe it doesn't really hold true to younger patients. That's why we are studying that now. But at least in elderly women who are infirm, the TAVR seems to be a lesser invasive therapy.

Dr. Anton Titov, MD: TAVI is associated with better gradients compared to open surgery to replace aortic valve. Dr. Kim Skelding published this in the American Journal of Cardiology. That is actually very important.

But one of the things that we do know now is that a lot of the outcomes to compare transcatheter aortic valve replacement vs. surgical aortic valve replacement relate to your ability to recover from stress. We are seeing a 90-pound woman or a 90-pound man.

Dr. Jeffrey Popma, MD: But we commonly see 90-pound women, who are 5 feet tall and very frail. The operations are just harder to do in those patients.

Dr. Anton Titov, MD: Because the hemodynamics of the size of aortic valve that can be placed is more challenging in surgery. The recovery time can be more problematic in women compared to men.

Dr. Jeffrey Popma, MD: So in those cases we do think that the TAVR is not just equivalent but preferred method to replace aortic valve. It is true particularly in the intermediate to high-risk patient pool. TAVI is better than the surgical aortic valve replacement.

Because we can get a larger aortic valve into a patient’s heart. It is relative to the size of the aortic annulus. We can achieve lower gradients across implanted aortic valve. We can leave the patients with less prosthesis-patient mismatch.

All those benefits are in addition to the rapid recovery time with TAVR.

Dr. Anton Titov, MD: Patients will be better by not having an open-heart aortic valve surgery.