Anatomic considerations of transcatheter aortic valve implantation (TAVI) have an important role for the procedure planning, but sex-specific data are lacking. All eligible cases undergoing evaluation for TAVI procedure in the period from November 2019 to July 2023 at the University Hospital of Split were included. Cardiac computed tomography was analysed to derive the measures of left ventricular outflow tract (LVOT), aortic root, ascending aorta, and ilio-femoral arteries. Sex-based comparison was conducted using the descriptive statistics. There were 140 female patients (43.8%) and 180 male patients (56.2%). Female patients had smaller dimensions of aortic annulus (area 391.9 vs. 491.5 mm2, p<0.001), LVOT (area 373.3 vs. 481.8 mm2, p<0.001) and ascending aorta (maximal diameter 32.7 vs. 34.5 mm, p<0.001), as well as ilio-femoral arteries bilaterally (p<0.001). There was no significant difference in the proportion of ilio-femoral unfeasibility for transfemoral TAVI procedure, as measured by diameter of ilio-femoral arteries <5.0 mm (9.0% in males vs. 6.1% in females, p=0.441) and <5.5 mm (24.7% in males vs. 16.7% in females, p=0.156). Female patients were more likely to receive the smallest valve across different valve platforms (p<0.001). There were sex-specific differences in the availability of conventional valve sizes across different platforms (p<0.001). Female patients had significantly higher periprocedural mortality (7.9% vs. 1.7%, p=0.030), while there were no differences in other clinical outcomes, and no association of periprocedural mortality with anatomic measures. Female patients showed smaller absolute dimensions of LVOT, aortic root and ilio-femoral arteries compared to male patients. There were no differences in the prevalence of ilio-femoral unfeasibility for transfemoral TAVI procedure, but there were sex-specific differences in the availability of conventional valve sizes across different platforms. Female patients exhibited higher periprocedural mortality with no difference in other clinical outcomes.

Aims: Several factors, including device design, annulus size, and sizing strategies, influence transcatheter heart valve (THV) haemodynamic outcomes in patients with aortic stenosis (AS). This sub-study evaluates early (30-day) echocardiographic outcomes of the Myval, Sapien, and Evolut THV series, focusing on haemodynamic performance and valve durability. Methods and results: The LANDMARK trial is a prospective, randomised, multicentre, open-label, non-inferiority trial comparing 384 patients implanted with Myval THV series to 384 receiving Sapien and Evolut THV series. Haemodynamic assessments followed Valve Academic Research Consortium-3 recommendations. At 30-day, haemodynamic device success rates were 85.9%, 77.8, and 85.4% for Myval, Sapien, and Evolut THV series, respectively (PMyval-Sapien = 0.03 and PMyval-Evolut = 0.98). Significant improvements in peak aortic flow velocity, pressure gradients, effective orifice area (EOA), Doppler velocity index (DVI), and cardiac indices were observed across all groups, except for unchanged left ventricular ejection fraction. Moderate prosthesis-patient mismatch (PPM) was less frequent with Myval THV series(11.3%) vs. Sapien THV series(21.8%), but higher than Evolut THV series (5.3%) (PMyval-Sapien = 0.0024, PMyval-Evolut = 0.0396), while severe PPM showed no significant differences (4.2% vs. 6.3% vs. 1.8%; PMyval-Sapien = 0.394, PMyval-Evolut = 0.2438). Rates of ≥ moderate paravalvular leak (PVL) were lower in Myval (3.5%), and Sapien (1.7%) compared with Evolut THV series (8.3%) (PMyval-Sapien = 0.3769, PMyval-Evolut = 0.0336). Myval THV series required minimal oversizing compared with Evolut THV series (P < 0.0001). Conclusion: The Myval THV series demonstrates short-term haemodynamic performance comparable to Evolut THV series and superior to Sapien THV series. Including intermediate sizes minimizes oversizing, underscoring its potential as an alternative for TAVI patients. Long-term follow-up is necessary to confirm these findings. Clinical trial registration: ClinicalTrials.gov: NCT04275726, EudraCT number 2020-000,137-40

Previous heterogenous studies show conflicting data about sex-based outcomes of non-ST-elevation acute coronary syndrome (NSTE-ACS) patients. This study evaluated 300 NSTE-ACS patients undergoing a coronary angiography between September 2012 and May 2015 that were managed with all-treatment strategies. The sample was stratified by sex and analyzed for the baseline characteristics and outcomes. The main outcome included major adverse cardiovascular and cerebrovascular events (MACCE), which were a composite of cardiac death, nonfatal myocardial infarction, ischemic stroke or urgent coronary revascularization. The female patients were older (median of 69.0 vs. 63.0 years, p = 0.008) and had lower values of BMI (median of 26.3 vs. 28.2 kg/m², p < 0.001) and eGFR (76.44 ± 22.43 vs. 94.04 ± 27.91 mL/min, p < 0.001). There was no significant difference in the treatment strategies, angiographic characteristics and discharge therapy between the groups (p > 0.05). The female patients had significantly higher unadjusted rates of ischemic stroke (4.2% vs. 0.5%, p = 0.023), cardiac mortality (11.3%, vs. 3.9%, p = 0.022) and MACCE (33.8%, vs. 19.5%, p = 0.014); female sex was a significant predictor of MACCE in the univariate analysis (HR 1.86, 95%CI 1.12–3.09, p = 0.014); and the cumulative incidence of MACCE was higher in female patients (p = 0.014). After the adjustment, the predictive effect of female sex became non-significant (HR 1.60, 95%CI 0.94–2.73, p = 0.083), while there was no difference in the cumulative incidence of MACCE among the propensity score matched cohort (p = 0.177). Female NSTE-ACS patients have worse long-term outcomes compared to their male counterparts. However, the differences disappear after adjustment and propensity score matching. Continuing efforts and health measures are required to alleviate any sex-based differences in the NSTE-ACS population.