Sex-Related Differences in Clinical Presentation and Outcome of Transcatheter Aortic Valve Implantation for Severe Aortic Stenosis
What is the impact of sex-related differences in transcatheter aortic valve implantation (TAVI) for high-risk patients with severe aortic stenosis?
The TAVI patients were included prospectively in a dedicated database from October 2006. The proportion of women (n = 131) was similar to that of men (n = 129). The Edwards valve (85.4%) and CoreValve (14.6%) were used through the transfemoral (65.0%), subclavian (3.1%), or transapical (31.9%) approach. All events were defined according to Valve Academic Research Consortium criteria.
Age was similar (83.1 ± 6.3 years), but women had less coronary and peripheral disease, less previous cardiac surgery, higher ejection fraction, and lower EuroSCORE (European System for Cardiac Operative Risk Evaluation [22.3 ± 9.0% vs. 26.2 ± 13.0%, p = 0.005]). Minimal femoral size (7.74 ± 1.03 mm vs. 8.55 ± 1.34 mm, p < 0.001), annulus size (20.9 ± 1.4 vs. 22.9 ± 1.7 mm, p < 0.001), and valve size (23.9 ± 1.6 vs. 26.3 ± 1.5 mm, p < 0.001) were smaller in women. Device success was similar (90.8% vs. 88.4%, p = 0.516) despite more frequent iliac complications (9.0% vs. 2.5%, p = 0.030). Residual mean aortic pressure gradient (11.6 ± 4.9 vs. 10.9 ± 4.9, p = 0.279) was also similar. The 1-year survival rate was higher for women, 76% (95% confidence interval, 72%-80%), than for men, 65% (95% confidence interval, 60%-69%); and male sex (hazard ratio, 1.62; 95% confidence interval, 1.03-2.53; p = 0.037) was identified as a predictor of mid-term mortality by Cox regression analysis.
The authors concluded that female sex is associated with better baseline clinical characteristics and improved survival.
In this study, female sex was associated with lower comorbidities and a lower EuroSCORE. Although no significant relationship with 30-day mortality was evidenced, female sex was associated with better mid-term survival and also identified as a predictor of mid-term survival. Despite women having smaller body, and femoral, aorta, and aortic annulus size, similar device success was achieved in women and men alike with an adequate reduction in the transprosthetic pressure gradient, making this an attractive procedure in appropriately selected patients.
Keywords: Test Vascular Medicine mm, Public Health Research
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