Challenges in the timely management of severe aortic stenosis: a multicentre analysis of delayed transcatheter aortic valve implantation referrals and gender disparities

Abstract Background Gender-related disparities in diagnosis and referral to transcatheter aortic valve implantation (TAVI) remain incompletely understood. Aims This study aims to assess sex-related differences in diagnostic and therapeutic delays to TAVI and to explore sex-related disparities in management and clinical characteristics of patients with severe aortic stenosis (AS). Methods and results This multicentre, observational study included 519 patients (46.1% women) with severe symptomatic AS referred for TAVI in 2023 across three European centres. Outcomes were assessed according to VARC-3. Female-specific clinical history was systematically collected. Women were older, with higher surgical risk (STS Score: 4.5 [3.0–6.6] vs. 2.8 [1.7–4.0], P < .001) and more advanced symptoms (New York Heart Association functional Classes III and IV 87 vs. 77, P = .014). Aortic annulus dimensions and valve area were smaller in women (both P < .001). Women experienced longer delays from symptom onset to diagnosis (3 [0–9] vs. 1 [0–4] month, P < .001), with notable inter-centre variability. However, time from diagnosis to TAVI was similar (3 [1–5] vs. 2.5 [1–4.5] months, P = .220). In-hospital mortality (2.5% vs. 1.8%, P = .555), bleeding, major vascular complications, and conduction disturbances did not differ by sex. At 6 months, functional status improved significantly; mortality (4.1% vs. 5.3%, P = .685), rehospitalization, and device success (84.6% vs. 85.8%, P = .252) were comparable between sexes. Female-specific characteristics, including pregnancy, gynaecological history, and hormone therapy, were not significantly associated with clinical outcomes. Conclusions Women faced longer diagnostic delays, indicating persistent sex-based disparities in the timely recognition of severe AS. Nevertheless, clinical outcomes after TAVI were similar between sexes, supporting comparable treatment effectiveness.