Transcatheter valvular interventions have been substantially increasing in the last decade worldwide and in the gulf region. Most of the valvular interventions are transcatheter aortic valve implantation (TAVI) followed by mitral transcatheter edge to edge repair (TEER) and less frequently tricuspid TEER, transcatheter mitral and tricuspid valve implantations. Despite the growing use of TAVI, there is still a lack of data on the outcomes of women vs. men in the Gulf region. Data from international registries represented in a metanalysis of 23,310 women undergoing TAVI showed that women are typically older and had less comorbidities compared to men1. Although they had similar all-cause 30-day mortality (6.5% in women vs. 6.2% in men, P=NS), women tend to have lower 1-year all-cause mortality (16% vs. 19.4%, p <0.001) 1. The lower long-term mortality was also seen in other registries.
However, when it comes to other procedural outcomes, such as: the need for non-TF access, major bleeding and the need for transfusion, major vascular complications and stroke, women tend to do worse 1. Data from SURTAVI registry indicate that women are more likely to have moderate-severe patient-prosthesis mismatch vs. men; 36.5% vs. 31.4% in the SAVR group, which was a lot lower for both groups with TAVI 10.2% in women vs. 13% in men 2. When it comes to the Gulf region the data is limited to draw any difference in outcomes. The Gulf TAVI registry, which included 795 patients who underwent TAVI 2017-2019 in Saudi Arabia, Oman Kuwait and Bahrain, and is the largest registry representing the Gulf region 3. It included 347 women and showed comparable demographics and procedural success with low event rates to detect a difference between women and men, although women tend to have better long term mortality4.
To better enhance outcomes and educate patients through informed consent, it is crucial to understand the variations in outcomes. The lack of data from the Gulf region stems from multiple reasons: the overall lower prevalence of degenerative aortic valve stenosis compared to major western societies, the absence of national registries, the under-utilization of TAVI and SAVR due to patient-related factors and access-related issues to tertiary centers. Same goes for degenerative mitral valve interventions and to some extent other structural interventions. Large epidemiological data suggests a significant increase in non-rheumatic calcific aortic stenosis (AS) and degenerative mitral valve disease from 1990 to 20175. However, the trajectory is not the same globally. While the prevalence is >350 cases of calcific AS per 100,000 in the US and some parts of Europe, the prevalence is only 50-100 cases per 100,000 in the Middle East5. Similarly, the prevalence of degenerative mitral valve disease is >350 cases per 100,000 in the US and some parts of Europe, and 150-200 per 100,000 in the Middle East 5. This partly could be related to lower life expectancy as aortic stenosis tends to be more common in the elderly population. The current life expectancy in Saudi for 2020 based on WHO is 73.1 for men and 76.1 for women, whereas in the US it is 76.3 for men and 80.7 for women and in Germany it is 78.4 in men and 84.8 in women. However, there might be other factors including a possible underdiagnosis.
In summary, we need larger registries inclusive of all the centers in the Gulf region to have meaningful insight on the outcomes of transcatheter valvular interventions and if there are major differences in outcomes between women and men.