Red blood cell distribution width and blood transfusions are associated with 2-year mortality after transcatheter aortic valve implantation in males but not in females: sex-related differences in hematological predictors

Preoperative anemia, transfusions, and simple hematological parameters like red blood cell distribution width (RDW) have been associated with worse outcomes in patients undergoing transcatheter aortic valve implantation (TAVI), with some heterogeneity of results. Hemoglobin (Hb) levels are physiologically different in males and females, and sex differences are increasingly recognized to play an important role in the prognosis of many cardiovascular diseases, including aortic valve stenosis. We aimed to evaluate the prognostic role of preoperative anemia, RDW, and periprocedural transfusions in TAVI patients followed up to 2 years, especially focusing on sex-related differences. 609 patients (median age 83 years, 53.9% females) undergoing TAVI at Verona University Hospital between March 2010 and June 2019 were retrospectively evaluated. Anemia before TAVI was highly prevalent (55.0%) in our population, mostly mild to moderate. Females were less anemic than males (48.8% versus 62.3%, p = 0.001) but experienced more vascular complications and were more frequently transfused within 30 days of the procedure (43.3% versus 28.8%, p < 0.001). Overall, anemic patients at baseline had a 2-year survival lower than non-anemic patients (Log-rank 5.915, p = 0.015). Similarly, patients with baseline RDW > 15% had reduced survival at 2 years compared to patients with normal RDW (Log-rank 14.038, p < 0.001). Grouping for sex, these differences only persisted in males. Multivariable analyses showed that hematological variables, such as periprocedural transfusions and RDW, were significant predictors of 2-year mortality in males but not in females. Our study highlights significant sex-related differences in the role of hematological parameters as independent predictors of 2-year mortality after TAVI.