OBJECTIVE: Management of patients with severe aortic stenosis (AS) may differ according to the patient sex. This study aimed to describe patterns of aortic valve replacement (AVR) for severe AS across Europe, including stratification by sex. METHODS: Procedure volume data for surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI) for six years (2015-2020) were extracted from national databases for Austria, Czech Republic, Denmark, England, Finland, France, Germany, Norway, Poland, Spain, Sweden, and Switzerland and stratified by sex. Patients per million population (PPM) undergoing AVR per year were calculated using population estimates from Eurostat. RESULTS: Between 2015 and 2019, AVR procedures grew at an average annual rate of 3.9%. In 2020, the average total PPM undergoing AVR across all countries was 339, with 51% of procedures being TAVI and 49% SAVR. AVR PPM varied widely between countries, with the highest and lowest in Germany and Poland, respectively. The average total PPM was higher for men than women (423 vs. 258), but a higher proportion of women (62%) than men (44%) received TAVI. The proportion of TAVI among total AVR procedures increased with age, with an overall average of 96% of men and 98% of women aged ≥85 years receiving TAVI; however, adoption of TAVI varied by country. CONCLUSIONS: The analysis of temporal trends in the adoption of TAVI vs. SAVR across Europe showed significant variations. Despite the higher use of TAVI vs. SAVR in women, overall rates of AV intervention in women were lower compared to men.

Department of Cardiology Inselspital Bern University Hospital University of Bern Freiburgstrasse 18 3010 Bern Switzerland

Department of Cardiology Liverpool Heart and Chest Hospital Thomas Dr Liverpool L14 3PE UK

Department of Cardiology Normandie Univ UNIROUEN U1096 CHU Rouen F 76000 Rouen France

Department of Thoracic and Cardiovascular Surgery Heart and Diabetes Centre North Rhine Westphalia University Hospital Ruhr University Bochum Bad Oeynhausen Germany

Division of Cardiology and Structural Heart Diseases Medical University of Silesia Ziolowa 45 47 Katowice 40 635 Poland

Division of Cardiology Department of Medicine 2 Medical University of Vienna Waehringer Guertel 18 20 1090 Vienna Austria

Edwards Lifesciences 1260 Nyon Switzerland

Edwards Lifesciences 18600 Prague Czech Republic

General and Interventional Cardiology Angiology Heart and Diabetes Centre North Rhine Westphalia Bad Oeynhausen Ruhr University Germany

Heart Institute Department of Cardiology Hospital University Germans Trias i Pujol Barcelona Spain

Institute for Pharmacology and Preventive Medicine Cloppenburg Germany

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