With Mirvat Alasnag, King Fahd Armed Forces Hospital, Jeddah - Saudi Arabia and Thomas Kümler, Steno Diabetes Center, Copenhagen, Herlev - Denmark

In this podcast, Mirvat Alasnag joins Thomas Kumler to discuss TAVI in women. References: 1. Tchetche D, Pibarot P, Bax JJ, Bonaros N, Windecker S, Dumonteil N, Nietlispach F, Messika-Zeitoun D, Pocock SJ, Berthoumieu P, Swaans MJ, Timmers L, Rudolph TK, Bleiziffer S, Leroux L, Modine T, van der Kley F, Auffret V, Tomasi J, Stastny L, Hengstenberg C, Andreas M, Leclercq F, Gandet T, Mascherbauer J, Trescher K, Prendergast B, Vasa-Nicotera M, Chieffo A, Mares J, Wesselink W, Rakova R, Kurucova J, Bramlage P, Eltchaninoff H. Transcatheter vs. surgical aortic valve replacement in women: the RHEIA trial. Eur Heart J. 2025;46:2079–88. doi:10.1093/eurheartj/ehaf133. https://academic.oup.com/eurheartj/article/46/22/2079/8103699 2. Eltchaninoff H, Bonaros N, Prendergast B, Nietlispach F, Vasa-Nicotera M, Chieffo A, Pibarot P, Bramlage P, Sykorova L, Kurucova J, Bax JJ, Windecker S, Dumonteil N, Tchetche D. Rationale and design of a prospective, randomized, controlled, multicenter study to evaluate the safety and efficacy of transcatheter heart valve replacement in female patients with severe symptomatic aortic stenosis requiring aortic valve intervention (Randomized researcH in womEn all comers wIth Aortic stenosis [RHEIA] trial). Am Heart J. 2020;228:27–35. https://www.sciencedirect.com/science/article/pii/S0002870320301964 3. Silva I, Alperi A, Hecht S, Zanuttini A, Théron A, Giuliani C, Camacho B, Dahou A, Mares J, Bax J, Bonaros N, Windecker S, Messika-Zeitoun D, Wesselink W, Rakova R, Bramlage P, Tchétché D, Eltchaninoff H, Pibarot P; RHEIA Trial Investigators. Echocardiographic results of transcatheter versus surgical aortic valve replacement in women with severe aortic stenosis: the RHEIA trial. J Am Heart Assoc. 2025. doi:10.1161/JAHA.125.047196. https://www.ahajournals.org/doi/10.1161/JAHA.125.047196 4. Eltchaninoff H, Windecker S, Mack MJ, Pibarot P, Thourani VH, Bax JJ, Cohen DJ, Bonaros N, Makkar R, Bleiziffer S, Szeto WY, Berthoumieu P, Hahn RT, Hovorka T, Mareš J, Taylor J, Tchetche D, Leon MB. Aortic Valve Replacement in Women: A Pooled Analysis of the RHEIA and PARTNER 3 Trials. JACC Cardiovasc Interv. 2025;18:1540-53. https://www.jacc.org/doi/10.1016/j.jcin.2025.03.036 5. Herrmann HC, Mehran R, Blackman DJ, Bailey S, Möllmann H, Abdel-Wahab M, Ben Ali W, Mahoney PD, Ruge H, Wood DA, Bleiziffer S, Ramlawi B, Gada H, Petronio AS, Resor CD, Merhi W, Garcia Del Blanco B, Attizzani GF, Batchelor WB, Gillam LD, Guerrero M, Rogers T, Rovin JD, Szerlip M, Whisenant B, Deeb GM, Grubb KJ, Padang R, Fan MT, Althouse AD, Tchétché D; SMART Trial Investigators. Self-expanding or balloon-expandable TAVR in patients with a small aortic annulus (SMART trial). N Engl J Med. 2024;390:1959–71. https://www.nejm.org/doi/10.1056/NEJMoa2312573 6. Herrmann HC, Tchetche D, Mehran R, et al. SMART trial 2-year outcomes: continued superior valve performance for the self-expanding TAVR system in small annulus patients. Presented at CRT 2025: 8-11 March 2025, Washington, DC, USA 7. Praz F, Borger MA, Lanz J, Marin-Cuartas M, Abreu A, Adamo M, Ajmone Marsan N, Barili F, Bonaros N, Cosyns B, De Paulis R, Gamra H, Jahangiri M, Jeppsson A, Klautz RJM, Mores B, Pérez-David E, Pöss J, Prendergast BD, Rocca B, Rossello X, Suzuki M, Thiele H, Tribouilloy CM, Wojakowski W; ESC/EACTS Scientific Document Group. 2025 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J. 2025;46:4635–736. https://academic.oup.com/eurheartj/article/46/44/4635/8234488 8. Mack MJ, Leon MB, Thourani VH, Makkar R, Kodali SK, Russo M, Kapadia SR, Malaisrie SC, Cohen DJ, Pibarot P, Leipsic J, Hahn RT, Blanke P, Williams MR, McCabe JM, Brown DL, Babaliaros V, Goldman S, Szeto WY, Genereux P, Pershad A, Pocock SJ, Alu MC, Webb JG, Smith CR; PARTNER 3 Investigators. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients (PARTNER 3). N Engl J Med. 2019;380:1695–705. https://www.nejm.org/doi/10.1056/NEJMoa1814052 9. Kodali S, Williams MR, Doshi D, Hahn RT, Humphries KH, Nkomo VT, Cohen DJ, Douglas PS, Mack M, Xu K, Svensson L, Thourani VH, Tuzcu EM, Weissman NJ, Leon M, Kirtane AJ. Sex-specific differences at presentation and outcomes among patients undergoing transcatheter aortic valve replacement: a cohort study. Ann Intern Med. 2016;164:377–84. https://www.acpjournals.org/doi/10.7326/M15-0121 10. Chieffo A, Petronio AS, Mehilli J, Chandrasekhar J, Sartori S, Lefèvre T, Presbitero P, Capranzano P, Tchetche D, Iadanza A, Sardella G, Van Mieghem NM, Meliga E, Dumonteil N, Fraccaro C, Trabattoni D, Mikhail G, Sharma S, Ferrer MC, Naber C, Kievit P, Baber U, Snyder C, Sharma M, Morice MC, Mehran R; WIN-TAVI Investigators. 1-Year Clinical Outcomes in Women After Transcatheter Aortic Valve Replacement: Results From the First WIN-TAVI Registry. JACC Cardiovasc Interv. 2018;11:1–12. https://www.jacc.org/doi/10.1016/j.jcin.2017.09.034 11. Tateishi K, Hmoud H, De Gregorio I, Hastings R, De Gregorio J. The impact of gender on outcomes of transcatheter aortic valve implantation between self-expanding valve and balloon-expandable valve. Cardiovasc Revasc Med. 2024;63:38–42. https://www.sciencedirect.com/science/article/abs/pii/S1553838924000034 12. Iribarren AC, AlBadri A, Wei J, Nelson MD, Li D, Makkar R, Merz CNB. Sex differences in aortic stenosis: identification of knowledge gaps for sex-specific personalized medicine. Am Heart J Plus. 2022;21:100197. https://pmc.ncbi.nlm.nih.gov/articles/PMC9629620/ 13. Springhetti P, Abdoun K, Clavel M-A. Sex differences in aortic stenosis: from the pathophysiology to the intervention, current challenges, and future perspectives. J Clin Med. 2024;13:4237. https://www.mdpi.com/2077-0383/13/14/4237 14. Tastet L, Kwiecinski J, Pibarot P, Capoulade R, Everett RJ, Newby DE, Shen M, Guzzetti E, Arsenault M, Bédard É, Larose É, Beaudoin J, Dweck M, Clavel MA. Sex-related differences in the extent of myocardial fibrosis in patients with aortic valve stenosis. JACC Cardiovasc Imaging. 2020;13:699–711. https://www.jacc.org/doi/10.1016/j.jcmg.2019.06.014 15. Treibel TA, Kozor R, Schofield R, Benedetti G, Fontana M, Bhuva AN, Sheikh A, López B, González A, Manisty C, Lloyd G, Kellman P, Díez J, Moon JC. Reverse myocardial remodeling following valve replacement in patients with aortic stenosis. J Am Coll Cardiol. 2018;71:860–71. https://www.jacc.org/doi/10.1016/j.jacc.2017.12.035 16. Stangl V, Baldenhofer G, Laule M, Baumann G, Stangl K. Influence of sex on outcome following transcatheter aortic valve implantation (TAVI): systematic review and meta-analysis. J Interv Cardiol. 2014;27:531–9. https://onlinelibrary.wiley.com/doi/epdf/10.1111/joic.12150 17. Tribouilloy C, Bohbot Y, Rusinaru D, Belkhir K, Diouf M, Altes A, Delpierre Q, Serbout S, Kubala M, Levy F, Maréchaux S, Enriquez Sarano M. Excess mortality and undertreatment of women with severe aortic stenosis. J Am Heart Assoc. 2021;10:e018816. 18. Bienjonetti-Boudreau D, Fleury M-A, Voisine M, Paquin A, Chouinard I, Tailleur M, et al. Impact of sex on the management and outcome of aortic stenosis patients. Eur Heart J. 2021;42(27):2683–2691. https://www.ahajournals.org/doi/10.1161/JAHA.120.018816

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