Women Have Better One Year Outcomes After TAVR
Although women with significant aortic valve disease who undergo transcatheter aortic valve replacement (TAVR) are considered higher risk than men in some respects, their survival rate after one year is higher, according to research published Dec. 19 in the Journal of the American College of Cardiology.
Using data from the Society of Thoracic Surgeons/ACC TVT Registry, the study examined more than 23,000 patients (49.9 percent women) receiving TAVR with older generation devices between 2011 and 2014. In general, the women were older and had higher predicted 30-day risk scores and were more likely to have other health issues at baseline, such as worsened kidney function, significant problems related to a leaking mitral heart valve and porcelain aorta. Men were more likely to be treated with percutaneous TAVR while women were more likely to have a surgical incision for TAVR. Additionally, although very rare, there was a greater chance that due to complications, the operating cardiologist or surgeon would need to abort TAVR and switch over to open surgery in women.
Despite the fact that they experienced more procedural problems, lower mortality was observed at one year in women compared to men (21.3 percent vs. 24.5 percent). The authors also found that with smaller and improved TAVR devices, women can increasingly undergo procedures percutaneously via the smaller artery in the groin, which would be expected to further reduce the risk of procedural complications.
“These findings are significant because it may mean heart teams are overestimating the risks of TAVR in some women and that also may mean that valve replacement is underutilized,” said Roxana Mehran, MD, FACC, the study’s senior researcher and chair of ACC’s Interventional Section. “In other words, some women who could benefit from TAVR may not be getting it. These study results also highlight that we need a robust scoring assessment that is specific to TAVR and catered to women so we can make the best decisions. Additionally, further study is needed on the medium- to long-term causes of death in men and women who have had TAVR, particularly studies that are focused on learning more about vascular biology and why the aorta becomes more calcified in women.”
In a related editorial comment, Molly Szerlip, MD, FACC, cautions that “the findings of this study are only applicable to the population that was studied and should not necessarily be extrapolated to lower risk populations or to patients who receive newer generation valves.”
Clinical Topics: Cardiac Surgery, Congenital Heart Disease and Pediatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Valvular Heart Disease, Aortic Surgery, Cardiac Surgery and CHD and Pediatrics, Cardiac Surgery and VHD, Congenital Heart Disease, CHD and Pediatrics and Interventions, CHD and Pediatrics and Quality Improvement, Interventions and Structural Heart Disease
Keywords: Aorta, Aortic Valve, Cause of Death, Heart Defects, Congenital, Heart Valve Diseases, Heart Valve Prosthesis, Poecilia, Registries, Surgeons, Survival Rate, Transcatheter Aortic Valve Replacement, STS/ACC TVT Registry, National Cardiovascular Data Registries
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