For the millions of adults living with severe aortic stenosis, the decision to pursue transcatheter valve replacement often hinges on age and sex — with clinicians and patients alike wondering whether outcomes meaningfully differ across these demographic boundaries. A large Danish cohort now provides unusually granular data suggesting they largely do not, a finding with real implications for how candidacy discussions are framed.
Drawing on 1,030 patients enrolled across three Danish university hospitals in the COMPARE-TAVI 1 trial — treated between June 2020 and November 2023 with transfemoral balloon-expandable valves — the analysis stratified outcomes across four age bands (under 70, 70–79, 80–89, and 90-plus) and by sex. One-year all-cause mortality was broadly flat across age groups, ranging from 5.6% in the 70–79 and 80–89 cohorts to 8.3% in the youngest group and 7.3% in the oldest, with identical 5.8% rates in both sexes. Stroke rates showed more variability — notably elevated at 6.7% in the under-70 group — while pacemaker implantation was substantially more common with advancing age, peaking at 19% in the 80–89 cohort. Women demonstrated smaller aortic annuli with higher residual gradients and lower effective orifice areas post-procedure, yet prosthesis-patient mismatch frequency was statistically similar between sexes at one year.
This analysis sits within a growing body of evidence challenging the assumption that TAVI is a diminishing-returns intervention in the very elderly. The comparable mortality and stroke profiles across age strata are consistent with prior registries such as the STS/ACC TVT Registry, though the Danish cohort's relatively small proportion of nonagenarians (4%) limits statistical power for that subgroup. The sex-based hemodynamic differences — particularly the smaller effective orifice areas in women — align with longstanding observations about sex-specific valve sizing challenges, and deserve continued prospective attention. As a post-hoc cohort analysis of a trial not powered for these subgroup comparisons, causal inference remains constrained. Still, the convergence of outcomes across demographic groups is incrementally reassuring for real-world clinical decision-making.