Sex-Related Differences in Clinical Presentation and Outcome of Transcatheter Aortic Valve Implantation for Severe Aortic Stenosis

• Published in: Journal of the American College of Cardiology Vol. 59; no. 6; pp. 566 - 571
• Main Authors: Hayashida, Kentaro, MD, PhD, Morice, Marie-Claude, MD, Chevalier, Bernard, MD, Hovasse, Thomas, MD, Romano, Mauro, MD, Garot, Philippe, MD, Farge, Arnaud, MD, Donzeau-Gouge, Patrick, MD, Bouvier, Erik, MD, Cormier, Bertrand, MD, Lefèvre, Thierry, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 07.02.2012; Elsevier; Elsevier Limited
• Subjects: Aged, 80 and over; aortic stenosis; Aortic Valve Stenosis - diagnosis; Aortic Valve Stenosis - epidemiology; Aortic Valve Stenosis - surgery; Biological and medical sciences; Cardiac Catheterization; Cardiology; Cardiology. Vascular system; Cardiovascular; Coronary vessels; Endocardial and cardiac valvular diseases; Female; Follow-Up Studies; France - epidemiology; Heart; Heart attacks; Heart surgery; Heart Valve Prosthesis Implantation - methods; Hospitals; Humans; Incidence; Internal Medicine; Male; Medical sciences; Mortality; Postoperative Complications - epidemiology; Prospective Studies; Risk Factors; Severity of Illness Index; sex differences; Sex Distribution; Sex Factors; Studies; Survival Rate - trends; transcatheter aortic valve implantation; Valve Academic Research Consortium; France; California; transcatheter aortic valve implantation; NYHA; body mass index; European System for Cardiac Operative Risk Evaluation; TAVI; LVEF; Valve Academic Research Consortium; SAVR; left ventricular ejection fraction; BSA; New York Heart Association; AS; aortic stenosis; VARC; mortality; EuroSCORE; surgical aortic valve replacement; sex differences; BMI; body surface area; Aortic stenosis; Prognosis; Sex; Cardiovascular disease; Implantation; Symptomatology; Phenotype; Cardiac valvular disease; Circulatory system; Cardiology; Severe; Aortic valve; Comparative study
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2011.10.877

Objectives The purpose of this study was to clarify the impact of sex-related differences in transcatheter aortic valve implantation (TAVI) for high-risk patients with severe aortic stenosis. Background Although TAVI is becoming a mature technique, the impact of sex differences remains unclear. Methods 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. Results 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 mm 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% to 80%), than for men, 65% (95% confidence interval: 60% to 69%); and male sex (hazard ratio: 1.62, 95% confidence interval: 1.03 to 2.53, p = 0.037) was identified as a predictor of midterm mortality by Cox regression analysis. Conclusions Female sex is associated with better baseline clinical characteristics and improved survival, and is identified as a predictor of midterm survival after TAVI.