Study: Heart Valve Replacement Has Different Risks for Women vs. Men

Sept. 22, 2026 — Following transcatheter aortic valve implantation (TAVI), disturbances in the heart’s electrical conduction system can make a pacemaker necessary. A recent study now shows that the significance of a pacemaker for subsequent prognosis differs between women and men. Physicians at Karl Landsteiner University (klu Krems) analyzed short- and long-term survival data from more than 1,100 people affected. The analysis revealed clear differences between women and men, suggesting that a more individualized assessment of risks before and after the procedure may be beneficial. This is becoming increasingly relevant as TAVI is also being used more frequently in younger people.

TAVI has fundamentally changed the treatment of severe narrowing of the aortic valve (aortic stenosis). It allows a new heart valve to be inserted via a catheter without the need for conventional open-heart surgery. However, disturbances in the heart’s electrical conduction system are among the more common consequences of the procedure and may require the implantation of a permanent pacemaker. Until now, their prognostic significance has largely been studied in women and men as a single group. Yet women and men differ considerably in terms of anatomy, cardiovascular disease and potential complications. A team of physicians from klu Krems therefore set out to investigate specifically whether the significance of a pacemaker for survival after TAVI also differs between the sexes.

Diagnosis: Difference

“Our results show that pacemaker status does not have the same prognostic significance in women and men,” says Dr. Cecilia Veraar of the Clinical Division of Internal Medicine III at University Hospital St. Pölten, a teaching and research site of klu Krems and first author of the study. “In women, we primarily see increased vulnerability immediately after the implantation of a new pacemaker, whereas in men, a pre-existing pacemaker may be an important indicator of long-term risk.”

The study was based on data from 1,114 people who underwent TAVI at University Hospital St. Pölten between 2016 and 2020. Of these, 555 were women and 559 were men. The team distinguished between three groups: people without a pacemaker, those who already had a pacemaker before TAVI, and those who required a new one within 30 days of the procedure. Both 30-day and five-year mortality were then analyzed separately by sex. A striking difference was already apparent at baseline: only 7.0 per cent of women had a pacemaker before TAVI, compared with 14.5 per cent of men. After the procedure, however, similar proportions of women and men required a new pacemaker – 12.8 and 14.7 per cent respectively.

The First 30 Days

The outcomes, however, revealed different patterns. In women, a newly implanted pacemaker was associated with poorer survival during the first 30 days. Severe bleeding was also significantly more common in women than in men; strokes, cardiac tamponade and resuscitation were numerically more frequent as well, although these individual complications did not reach statistical significance. After five years, by contrast, pacemaker status had no discernible impact on survival in women. In men, the picture was almost the reverse: there were no short-term differences, but in the long term, men who already had a pacemaker before TAVI had the least favorable prognosis. This association remained even after other risk factors had been taken into account.

For Prof. Julia Mascherbauer, head of the Clinical Division of Internal Medicine III at University Hospital St. Pölten and senior author of the study, such differences are becoming increasingly relevant in clinical practice. Today, TAVI is no longer used exclusively in very elderly, high-risk patients. As its use expands to younger groups, the period over which cardiac conduction disorders and pacemaker therapy may have an impact becomes longer. The findings therefore support taking sex-specific factors more fully into account in risk assessment, counseling and follow-up care. At the same time, the researchers point out that a pre-existing pacemaker in men is probably primarily an indicator of more advanced cardiovascular disease and should not itself be interpreted as the cause of higher mortality. The study forms part of klu Krems’ interdisciplinary research into issues of major relevance to health and health policy.

Original publication: Pacemaker Status and 5-Year Mortality After TAVI: A Sex-Specific Analysis, C. Veraar; G. Lamm; M. Will; M. Hammerer; M. Granner; L. Merl; K. Schwarz; J. Mascherbauer, European Journal of Clinical Investigation 2026; 56:e70242, doi: 10.1111/eci.70242. https://kris.kl.ac.at/en/publications/pacemaker-status-and-5-year-mortality-after-tavi-a-sex-specific-a/