Sex-specific anatomical challenges in TAVR: A closer look at bicuspid aortic valve stenosis

Background: This paper seeks to examine the findings of the recently published study by Gitto et al., titled "Clinical Outcomes in Women and Men with Raphe-Type Bicuspid Aortic Valve Stenosis Undergoing Transcatheter Aortic Valve Replacement," and to conduct a further analysis of the potential influencing factors. Methods: A critical analysis was conducted on this published multicenter registry study, with a focus on the finding that female patients have a higher risk of valve migration after transcatheter aortic valve replacement (TAVR). In-depth discussions were carried out from the perspectives of sex-related anatomical differences of the aorta and device selection. Results: The original study indicated that female patients have a higher risk of post-TAVR valve migration and a lower technical success rate. This analysis suggests that, in addition to the factors mentioned in the original study (e.g., more frequent use of self-expandable valves and intra-annular downsizing), female-specific anatomical characteristics-such as a more horizontal aortic angle, more significant vascular tortuosity, and smaller iliac artery diameter-may jointly affect device delivery, positioning, and release stability, thereby contributing to such outcome disparities. Furthermore, it is recommended that the original study data be further analyzed to evaluate the impact of different types of self-expandable valves (e.g., ACURATE neo2) on valve positioning. Conclusion: In patients with raphe-type bicuspid aortic valve stenosis, sex-related anatomical variations and device selection discrepancies are important factors affecting TAVR outcomes. Future research and technological development should fully take these factors into account to achieve more personalized treatment strategies.