Transcatheter Aortic Valve Implantation in Women-Specific Issues

Abstract

Transcatheter aortic valve implantation (TAVI) has become a cornerstone in the management of severe aortic stenosis across a broad spectrum of surgical risk categories. Women undergoing TAVI represent nearly half of all patients, yet they exhibit distinct baseline, anatomical, procedural, and outcome characteristics compared to men. Women are typically older at presentation, have smaller aortic annuli and ilio-femoral vessels, and exhibit distinct patterns of left ventricular remodeling. These anatomical and physiological features influence device selection, procedural strategy, and risk of complications. Despite higher procedural risks – especially vascular and bleeding complications – women demonstrate superior long-term survival after TAVI compared to men. This article provides a comprehensive, women-focused review of TAVI by incorporating evidence from major registries, clinical trials, and recent sex-specific reviews. It explores baseline differences, procedural implications, complications, outcomes, mechanistic explanations, clinical recommendations, and future research priorities, aiming to highlight the need for a women-centric approach to TAVI.