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Original research
Sex differences in patients undergoing transcatheter aortic valve replacement in Asia
  1. Paul T L Chiam1,
  2. Kentaro Hayashida2,
  3. Yusuke Watanabe3,
  4. Wei-Hsian Yin4,
  5. Hsien-Li Kao5,
  6. Michael K Y Lee6,
  7. Fabio Enrique Posas7,
  8. Mann Chandavimol8,
  9. Wacin Buddhari9,
  10. Timothy C Dy10,
  11. Ngoc Quang Nguyen11,
  12. Won Jang Kim12,
  13. Kiyuk Chang13,
  14. Mao-Shin Lin14,
  15. Yat-Yin Lam15,
  16. Hung Manh Pham11,
  17. Shaiful Azmi Yahaya16,
  18. Kay Woon Ho17,
  19. Wenzhi Pan18,
  20. Xian-bao Liu19,
  21. Jian'an Wang20,
  22. Hyo Soo Kim21 and
  23. Mao Chen22
  1. 1The Heart and Vascular Centre, Mount Elizabeth Medical Centre, Singapore
  2. 2Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
  3. 3Department of Cardiology, Teikyo University Hospital, Tokyo, Japan
  4. 4Division of Cardiology, Heart Center, Cheng-Hsin General Hospital, Taipei, Taiwan
  5. 5Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
  6. 6Department of Cardiology, Queen Elizabeth Hospital, Hong Kong, Hong Kong
  7. 7Department of Cardiology, St. Luke's Medical Centre, Manila, Philippines
  8. 8Division of Cardiology, Ramathibodi Hospital, Bangkok, Thailand
  9. 9Medicine, Chulalongkorn University, Bangkok, Thailand
  10. 10Heart Institute, Chinese General Hospital and Medical Centre, Manila, Philippines
  11. 11Department of Cardiology, Vietnam National Heart Institute, Hanoi, Vietnam
  12. 12Department of Cardiology, CHA Bundang Medical Centre, Seoul, Republic of Korea
  13. 13Cardiology, The Catholic University of Korea Seoul St. Mary's Hospital, Seoul, Republic of Korea
  14. 14Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
  15. 15Hong Kong Asia Heart Centre, Canossa Hospital, Hong Kong, Hong Kong
  16. 16Department of Cardiology, National Heart Institute, Kuala Lumpur, Malaysia
  17. 17Department of Cardiology, National Heart Centre Singapore, Singapore
  18. 18Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
  19. 19Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
  20. 20Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
  21. 21Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
  22. 22Department of Cardiology, Sichuan University West China Hospital, Chengdu, China
  1. Correspondence to Dr Paul T L Chiam; paulchiam{at}


Objectives Transcatheter aortic valve replacement (TAVR) is increasingly performed. Physically small Asians have smaller aortic root and peripheral vessel anatomy. The influence of gender of Asian patients undergoing TAVR is unknown and may affect outcomes. The aim of this study was to assess sex differences in Asian patients undergoing TAVR.

Methods Patients undergoing TAVR from eight countries were enrolled. In this retrospective analysis, we examined differences in characteristics, 30-day clinical outcomes and 1-year survival between female and male Asian patients.

Results Eight hundred and seventy-three patients (54.4% women) were included. Women were older, smaller and had less coronary artery and lung disease but tended to have higher logistic EuroSCOREs. Smaller prostheses were used more often in women. Major vascular complications occurred more frequently in women (5.5% vs 1.8%, p<0.01); however, 30-day stroke and mortality (women vs men: 1.5% vs 1.6%, p=0.95% and 4.3% vs 3.4%, p=0.48) were similar. Functional status improvement was significant and comparable between the sexes. Conduction disturbance and permanent pacemaker requirements (11.2% vs 9.0%, p=0.52) were also similar as was 1-year survival (women vs men: 85.6% vs 88.2%, p=0.25). The only predictors of 30-day mortality were major vascular injury in women and age in men.

Conclusions Asian women had significantly smaller stature and anatomy with some differences in clinical profiles. Despite more frequent major vascular complications, women had similar 30-day stroke or mortality rates. Functional status improvement was significant and comparable between the sexes. Conduction disturbance and permanent pacemaker requirements were similar as was 1-year survival.

  • transcatheter aortic valve replacement
  • aortic valve stenosis
  • heart valve prosthesis implantation

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  • Contributors PTLC conceived the study, interpreted the data and wrote the manuscript. NQN performed the statistical analyses and reviewed the manuscript. All other authors helped to critically revise the manuscript and approved the final manuscript. PTLC takes responsibility for the overall content as a guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests PTLC, KH, YW, W-HY, MKYL, MC, WJK, KC, M-SL and HSK have served as proctors for Edwards Lifesciences. PTLC, YW, W-HY, H-LK, MKYL, WB, Dy, KC, M-SL, KWH and HSK have served as proctors for Medtronic. WJK has served as a consultant for Medtronic.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. All data are deidentified and stored in a secure stand-alone computer.

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