Gender-Specific Outcomes With TAVR

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.

Clinical Topics: Cardiac Surgery, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Valvular Heart Disease, Aortic Surgery, Cardiac Surgery and Heart Failure, Cardiac Surgery and VHD, Interventions and Imaging, Interventions and Structural Heart Disease, Angiography, Nuclear Imaging

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


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