Beyond Sex-Based Differences: Exploring the Complexities of Aortic Stenosis in Women

Abstract

to women’s higher post-operative mortality, higher frailty, and elevated risk of patient prosthesis mismatch, due to smaller annular sizes. 5-7 However, after the advent of transcatheter aortic valve replacement (TAVR), this disparity has decreased, with an equal representation of women in the utilization of this procedure in the main studies. 8,9 Curiously, despite worse pre-procedural female profile and higher rates of bleeding and vascular complications, TAVR has demonstrated improved long-term survival in women, compared to men. 10 Moreover, women have shown improved reverse remodeling of myocardial hypertrophy post-procedure, compared to men. 11 This study highlighted the discussion of this critical topic, adding relevant information about innate physiological differences in AS between men and women, but gaps still remain in the current knowledge, and future randomized trials are necessary to elucidate them. Furthermore, the equality in representation of women among TAVR studies does not necessarily translate to equal care and, particularly, optimal timing of valve intervention. Future research should focus on exploring the advantages of using sex-specific guidelines for indicating valve procedures, taking into account the inherent physiological sex variations in AS phenotypes and identifying healthcare factors that may contribute to unequal treatment of women with severe AS.