Sex-related differences in hospital outcomes after balloon aortic valvuloplasty

Background

Sex differences in the prevalence and characteristics of cardiac pathologies, including aortic stenosis (AS), are well-documented. For instance, females with severe AS exhibit lower degrees of calcification but higher levels of fibrosis compared to males. This study aims to evaluate sex-based differences in in-hospital outcomes among patients with AS undergoing balloon aortic valvuloplasty (BAV).

Methods

National Inpatient Sample database was queried from 2015 to 2019, identifying adult patients with severe nonrheumatic AS undergoing BAV using ICD-10 codes. Statistical analyses included Chi-Squared tests for initial comparisons followed by logistic regression to adjust for covariates.

Results

The study included 19,510 patients: 10,556 males (54.1 %) and 8954 females (45.9 %). Females demonstrated lower rates of post-procedural in-hospital mortality, acute kidney injury, infection, ventricular arrhythmias, and pneumothorax, however higher incidence of stroke or transient ischemic attack (TIA), red blood cell transfusions, vascular complications, and pericardial effusion. Adjusted analysis revealed female patients had lower mortality rates (OR 0.89; 95 % CI [0.79–1.0]; p = 0.042), but higher rates of red blood cell transfusions (OR 1.6; 95 % CI [1.4–1.8]; p < 0.001) and vascular complications (OR 1.5; 95 % CI [1.3–1.8]; p < 0.001), without significant difference in stroke (OR 1.1; 95 % CI [0.91–1.3]; p = 0.309).

Conclusions

Females undergoing BAV for severe AS experienced lower in-hospital mortality but higher rates of vascular complications and red blood cell transfusions compared to males. These findings underscore the importance of a sex-specific approach in the management of AS to reduce adverse outcomes and optimize patient care.