AIMS: There is an increasing awareness of gender-related differences in patients with severe aortic stenosis and their outcomes after surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI). METHODS: Data from the IMPULSE registry were analysed. Patients with severe aortic stenosis (AS) were enrolled between March 2015 and April 2017 and stratified by gender. A subgroup analysis was performed to assess the impact of age. RESULTS: Overall, 2171 patients were enrolled, and 48.0% were female. Women were characterised by a higher rate of renal impairment (31.7 vs 23.3%; p<0.001), were at higher surgical risk (EuroSCORE II: 4.5 vs 3.6%; p=0.001) and more often in a critical preoperative state (7.0vs 4.2%; p=0.003). Men had an increased rate of previous cardiac surgery (9.4 vs 4.7%; p<0.001) and a reduced left ventricular ejection fraction (4.9 vs 1.3%; p<0.001). Concomitant mitral and tricuspid valve disease was substantially more common among women. Symptoms were highly prevalent in both women and men (83.6 vs 77.3%; p<0.001). AVR was planned in 1379 cases. Women were more frequently scheduled to undergo TAVI (49.3 vs 41.0%; p<0.001) and less frequently for SAVR (20.3 vs 27.5%; p<0.001). CONCLUSIONS: The present data show that female patients with severe AS have a distinct patient profile and are managed in a different way to males. Gender-based differences in the management of patients with severe AS need to be taken into account more systematically to improve outcomes, especially for women.

4th Medical Department Hietzing Hospital Vienna Austria

Cardiology Department AKH Celle Celle Germany

Centre Hospital d'Annecy Annecy France

Department for Cardiology Helios Erfurt Clinic Erfurt Germany

Department of Cardiology and Angiology University of Kiel Kiel Germany

Department of Cardiology Heart and Diabetes Center Bad Oeynhausen Ruhr University of Bochum Bad Oeynhausen Germany

Department of Cardiology University of Erlangen Erlangen Germany

Department of Cardiothoracic Surgery Foundation IRCCS Policlinico S Matteo Pavia Italy

Department of Cardiovascular Surgery 2nd Faculty of Medicine Charles University Prague Czech Republic

Department of Cardiovascular Surgery Institute for Clinical and Experimental Medicine Prague Czech Republic

Division of Cardiology and URT CNR of IFC University Magna Graecia Catanzaro Italy

Edwards Lifesciences Nyon Switzerland

Edwards Lifesciences Prague Czech Republic

Herzkatheterlabor Nymphenburg and Department of Cardiology University of Munich Munich Germany

Institute for Pharmacology and Preventive Medicine Cloppenburg Germany

Interventional Cardiology Unit Hospital de la Santa Creu i Sant Pau Barcelona Spain

James Cook University Hospital Middlesbrough UK

Queen Elizabeth Hospital and Institute of Cardiovascular Sciences University of Birmingham Birmingham UK

Sapienza University of Rome Rome Italy

St Bartholomew's Hospital London UK

University of Amsterdam Amsterdam Netherlands

University of Bari Bari Italy

University of Ottawa Heart Institute Ottawa Ontario Canada

University of Turin Turin Italy

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Sex-related disparities in aortic stenosis from disease awareness to treatment: a state-of-the-art review