Effect of Prosthesis-Patient Mismatch in TAVR Studied for Women Versus Men

May 1, 2025—The Society for Cardiovascular Angiography & Interventions (SCAI) announced the presentation of data demonstrating that women are 8% more likely than men to experience major complications after transcatheter aortic valve replacement (TAVR).

The findings were presented at the SCAI 2025 scientific sessions held May 1-3 in Washington, DC. The SCAI 2025 abstract is available here. Additionally, the study was published by Karim Al-Azizi, MD, et al online in JSCAI.

The SCAI press release noted that prosthesis-patient mismatch (PPM)—a key challenge for successful TAVR—disproportionately affects women because of anatomic differences such as smaller aortic annulus size. Although self-expanding valves (SEVs) are generally associated with better hemodynamic performance compared to balloon-expandable valves (BEVs), the long-term impact of PPM severity—particularly in women—remains unclear, stated SCAI.

According to SCAI, the investigators conducted a retrospective cohort study of 3,016 patients (1,338 women) who underwent native valve TAVR from 2012 to 2021. The primary outcome was all-cause mortality at 5 years, with secondary outcomes including PPM incidence, severity, and residual transvalvular gradients.

As summarized in the SCAI press release, the investigators found the following outcomes for women compared to men:

• The rate of predicted PPM was significantly higher (26.2% vs 18.2%).
• The rate of measured PPM was similar (26.7% vs 24.1%).
• Long-term (5-year) survival outcomes were similar or improved in women compared to men across all levels of PPM severity.
• Neither moderate nor severe predicted PPM or measured PPM negatively impacted long-term survival in women.

The study showed that SEVs compared to BEVs were linked to markedly lower rates of predicted PPM (12.8% vs 31.8%) and measured PPM (16.1% vs 31.1%), as well as larger orifice areas, which is known to be the case with SEVs.

Additionally, there were no significant risk-adjusted survival differences between valve types, emphasizing the importance of individualized prosthesis selection and lifetime valve management considerations, noted the press release.

Dr. Al-Azizi, the study’s lead author, who is from Baylor Scott & White Health—The Heart Hospital in Plano, Texas, commented on the data in the SCAI press release.

“These findings highlight the importance of selecting the right valve based on a comprehensive, long-term treatment strategy—not just immediate echocardiographic metrics that may have little influence on long-term outcomes,” stated Dr. Al-Azizi. “This is a timely study, as the SMART data was recently released, and there was no clinical difference between valve types nor an increased risk of needing valve reinterventions. This also underscores the critical need to evaluate TAVR outcomes specifically in women, where assumptions about risk and benefit may not hold true, and overlooking those differences could lead to poor long-term outcomes.”

In April 2024, the 1-year results from SMART were presented at ACC.24, the American College of Cardiology’s annual scientific session in Atlanta, Georgia, and published by Howard C. Herrmann, MD, et al in The New England Journal of Medicine. An analysis of the SMART trial was presented at the SCAI scientific session in May 2024.