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This study assessed sex-specific differences in baseline characteristics, procedural approaches, hemodynamic outcomes, and their impact on 5-year all-cause mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed data from 20,094 patients in the IMPPACT TAVR registry. Hemodynamic outcomes, including prosthesis-patient mismatch (PPM), were defined according to Valve Academic Research Consortium-3 criteria. Kaplan\u2013Meier and Cox models assessed 5-year all-cause mortality, and logistic regression identified predictors of PPM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Women comprised 49.1% of the cohort. They were older (81.4 vs. 80.2 years,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), more symptomatic (NYHA\u2009\u2265\u2009III: 74.4% vs. 67.6%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), and more frequently received self-expanding valves (66.5% vs. 45.7%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Post-TAVR indexed effective orifice areas were slightly larger in women (1.01\u2009\u00b1\u20090.28 vs. 0.99\u2009\u00b1\u20090.27cm\n                      <jats:sup>2<\/jats:sup>\n                      \/m\n                      <jats:sup>2<\/jats:sup>\n                      ,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Five-year mortality was lower in women (HR 0.81, 95% CI 0.76\u20130.86,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Severe PPM occurred less frequently in women (4.0% vs. 4.5%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and was associated with increased mortality only in men (HR 1.32, 95% CI 1.10\u20131.59,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002). Adjustment for comorbidities nullified the association between PPM and mortality in both sexes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this international TAVR cohort, women, despite being older, demonstrated better survival than men, with comparable postprocedural hemodynamic outcomes. Severe PPM was associated with increased mortality only in men, likely reflecting underlying comorbidities and low-flow states. After adjustment for confounders, PPM was no longer associated with survival in either sex. These findings underscore the need for strategies accounting for both procedural and patient-specific risks, beyond prosthesis hemodynamics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Graphical Abstract<\/jats:title>\n                    <jats:p>\n                      Sex-Specific Differences in TAVR, (\n                      <jats:bold>A<\/jats:bold>\n                      ) Kaplan-Meier curves with 95% CI for all-cause mortality stratified by sex. (\n                      <jats:bold>B<\/jats:bold>\n                      ) TTE-derived non-indexed and BSA-indexed pre-TAVR AVA and post-TAVR EOA stratified by sex. (\n                      <jats:bold>C<\/jats:bold>\n                      ) Distribution of PPM severity stratified by device type and sex. (\n                      <jats:bold>D<\/jats:bold>\n                      ) Forest plot showing results of the multivariable Cox proportional hazards model for 5-year all-cause mortality including a comparison of severe PPM against non-severe PPM (no and moderate) in men and women. HR with 95% CI are shown. Study center was included as a random effect in the model. Abbreviations: AVA: aortic valve area; BE: balloon-expandable; CI: confidence interval; EOA: effective orifice area; GFR: glomerular filtration rate; HR: hazard ratio; KM: Kaplan-Meier; LVEF: left ventricular ejection fraction; PPM: prosthesis-patient mismatch; PVL: paravalvular leak; SE: self-expanding\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00392-025-02794-2","type":"journal-article","created":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T08:38:49Z","timestamp":1763627929000},"page":"1207-1217","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Sex differences in hemodynamics and outcomes after transcatheter aortic valve 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Dr Bunc served as proctor for TAVR procedures with Edwards Lifesciences, Medtronic, Meril, and Abbott; is a member of the advisory boards for Medtronic and Edwards Lifesciences. Dr Van Mieghem received institutional research grants from Abbott Vascular, Boston Scientific, Medtronic, Teleflex, PulseCath BV and advisory fees from Abbott Vascular, Boston Scientific, Medtronic, Anteris, JenaValve, Siemens, Materialise, Pie Medical, Luma Vision, Daiichi Sankyo, Bolt Medical. Dr Abdel-Wahab\u2019s institution has received speaker\u2019s honoraria and\/or consultancy fees from Boston Scientific, and Medtronic. Dr Kim has received proctor and personal fees from Abbott, Boston Scientific, Meril Life Sciences, and Shockwave Med; is a member of the advisory boards for Abbott, Boston Scientific, and HID Imaging; and Dr Kim\u2019s institution has received fees from Boston Scientific. Dr Nombela-Franco has served as proctor for Abbott and Edwards Lifesciences. Dr Rudolph received lecture fees from Abbott, SIS Medical and Translumina. Dr Schmidt is proctor for Medtronic and Boston and received speaker honoraria and travel expenses from Medtronic, Boston, Meril and Edwards Lifesciences. Dr Toggweiler has received honoraria from Medtronic, Boston Scientific, Biosensors, Hi-D Imaging, Abbott Vascular, Medira, Shockwave, Teleflex, atHeart Medical, Cardiac Dimensions, Polares Medical, Amarin, Sanofi, AstraZeneca, ReCor Medical, Daiichi Sankyo; has received institutional research grants from Edwards Lifesciences, Abbott Vascular, Boston Scientific, Fumedica, Novartis, Boehringer Ingelheim, Polares Medical, and holds equity in Hi-D Imaging. Dr Veulemans has received speaker and\/or study honoraria from Edwards Lifesciences, Medtronic, and Boston Scientific. Dr Wienemann has received travel grants from JenaValve. Dr Witberg has received consultancy fees from Medtronic. Dr Zeus received speaker and\/or study honoraria from Edwards Lifesciences, Medtronic, and Boston Scientific.All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}}]}}