Gender-Specific Outcomes With TAVR

Jan 04, 2017
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Authors:
Chandrasekhar J, Dangas G, Yu J, et al.
Citation:
Sex-Based Differences in Outcomes With Transcatheter Aortic Valve Therapy: TVT Registry From 2011 to 2014. J Am Coll Cardiol 2016;68:2733-2744.
Summary By:
Troy M LaBounty, MD, FACC

Study Questions:

Are there gender-specific differences in outcomes among patients treated with transcatheter aortic valve replacement (TAVR)?

Methods:

This study examined clinical, procedural, and outcome data from the national Society of Thoracic Surgeons (STS)/American College of Cardiology Transcatheter Valve Therapy Registry of patients undergoing TAVR in the United States, and compared outcome differences between men and women.

Results:

This study evaluated 11,808 women and 11,844 men treated with TAVR. Women were slightly older, had lower rates of prior coronary interventions, had a higher STS risk score, were less likely to have prior cardiac surgery, and had lower rates of cardiomyopathy (p < 0.001 for each). Women had lower rates of transfemoral access and were treated with smaller valve sizes than men (p < 0.001 for each). There were no differences between women and men in regards to in-hospital death, stroke, or myocardial infarction (p = 0.53), although major vascular complications were more common in women (adjusted odds ratio, 1.7; p < 0.001). At 1 year, women had lower rates of adjusted mortality (hazard ratio, 0.73; p < 0.001), with no difference in stroke, myocardial infarction, or clinically significant bleeding (p > 0.05 for each).

Conclusions:

While there are differences in clinical and procedural characteristics between men and women, women have significantly lower rates of adjusted mortality at 1 year following TAVR.

Perspective:

Despite a higher mean STS risk score and increased age, women have a significantly lower rate of adjusted 1-year mortality after TAVR. While mortality at discharge was similar between genders, the increased 1-year survival in women suggests that there may be differences in baseline and/or procedural characteristics that are incompletely accounted for on multivariable analyses, or gender-specific characteristics that explain this difference in mortality.

Keywords: Angiography, Aortic Valve, Cardiomyopathies, Cardiac Surgical Procedures, Heart Valve Diseases, Myocardial Infarction, Risk, Stroke, Transcatheter Aortic Valve Replacement


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