Karl Landsteiner University Study finds sex differences in pacemaker outcomes after TAVI in Austria
TAVI is widely used to treat severe aortic stenosis, a condition in which narrowing of the aortic valve restricts blood flow from the heart.
AUSTRIA— A study by researchers at Karl Landsteiner University (klu Krems) has identified differences between women and men in the relationship between pacemaker use and survival after transcatheter aortic valve implantation (TAVI).
The researchers analyzed short and long-term outcomes among 1,114 people who underwent TAVI at University Hospital St. Pölten between 2016 and 2020.
The analysis found that pacemaker status had different implications for women and men, with differences emerging in both the timing and nature of associated risks.
TAVI is widely used to treat severe aortic stenosis, a condition in which narrowing of the aortic valve restricts blood flow from the heart.
The minimally invasive procedure allows doctors to replace the damaged valve through a catheter rather than conventional open heart surgery.
However, the procedure can affect the heart’s electrical conduction system, sometimes making a permanent pacemaker necessary.
Study examines sex specific outcomes
The research team divided participants into three groups: those without a pacemaker, those who already had a pacemaker before TAVI, and those who received a new pacemaker within 30 days of the procedure.
The researchers then assessed mortality at 30 days and five years, analysing women and men separately.
Of the participants, 555 were women, and 559 were men. Before TAVI, 7.0% of women had a pacemaker compared with 14.5% of men.
Following the procedure, however, the proportion requiring a new pacemaker was similar, at 12.8% among women and 14.7% among men.
The researchers observed different patterns in the subsequent outcomes.
Among women, receiving a new pacemaker was associated with poorer survival during the first 30 days after TAVI. Severe bleeding also occurred significantly more often in women.
Strokes, cardiac tamponade and resuscitation were numerically more frequent among women, although these differences did not reach statistical significance.
After five years, pacemaker status was not associated with a detectable difference in survival among women.
Among men, the researchers found no short-term survival difference associated with pacemaker status.
Over five years, however, men who had a pacemaker before undergoing TAVI had the least favourable survival outcomes.
The association persisted after the researchers adjusted for other risk factors.
Implications for patient assessment
Dr Cecilia Veraar of the Clinical Division of Internal Medicine III at University Hospital St. Pölten and the study’s first author said the findings indicate that pacemaker status does not have the same prognostic significance in women and men.
Prof. Julia Mascherbauer, head of the Clinical Division of Internal Medicine III and senior author, said the findings are relevant as TAVI expands beyond its traditional use in very elderly, high-risk patients.
The researchers noted that longer TAVI use among younger patients could extend the period during which conduction disorders and pacemaker therapy may affect their health.
They also said that a pre-existing pacemaker in men may reflect more advanced cardiovascular disease rather than directly causing higher mortality.
The study forms part of klu Krems’ interdisciplinary research into cardiovascular health and health policy.
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