Sex-Related Differences in Outcomes After Transcatheter Aortic Valve Implantation

Abstract

Studies were initially screened at the level of title and abstract, and then full-length reports were retrieved for detailed evaluation. Two authors independently selected articles according to prespecified inclusion and exclusion criteria. Articles were included if they (1) reported Background-There were considerable discrepancies with regard to sex-related differences in complications and prognosis after transcatheter aortic valve implantation. Methods and Results-The Cochrane library and PubMed online databases were searched. Articles reporting sex-specific post-transcatheter aortic valve implantation complications and mortality were identified. Two authors selected studies and extracted data independently. Random-and fixed-effects models were used depending on between-study heterogeneity. There were 27 articles, a total of 9118 patients, enrolled in our systematic review and meta-analysis, including 4176 men and 4942 women. Pooled analyses suggested considerable sex-related differences in complications and early as well as midterm outcomes after transcatheter aortic valve implantation. The difference in the risk for heart block requiring permanent pacemaker implantation was noted to be significant only in the subgroup of the CoreValve-dominating studies (pooled risk ratio [RR, men versus women], 1.29; 95% confidence interval [CI], 1.13-1.47). Although men had significantly lower risks for major/life-threatening bleeding (pooled RR, 0.81; 95% CI, 0.68-0.96) and major vascular complications (pooled RR, 0.49; 95% CI, 0.37-0.66), they had poorer prognosis. In fact, male sex was associated with significantly higher risks for deaths at both 30 days (RR, 1.37; 95% CI, 1.07-1.76) and 1 year (RR, 1.30; 95% CI, 1.14-1.49). Conclusions-Although men had lower risks for major/life-threatening bleeding and major vascular complications after transcatheter aortic valve implantation, they had less favorable short-term and midterm survival. (Circ Cardiovasc Interv. 2013;6:543-551.)

Effect of Gender After Transcatheter Aortic Valve Implantation: A Meta-Analysis

“…The results of the present meta-analysis are in line with the recent work of Zhao and colleagues [18], although the two meta-analyses mainly differ in the selection criteria applied. Our meta-analysis included only studies reporting adjusted midterm mortality to understand in a more accurate way the independent role of gender after TAVI.…”

“…A recent meta-analysis on the same topic reported better short-term and midterm survival for women. One of the most intriguing questions that the previously cited report left unsolved, however, is the effect of female gender itself on outcomes after TAVI: actually, the included studies were not adjusted for confounding variables [18]. Thus, we decided to perform a meta-analysis of observational results evaluated after adjustment for clinical and procedural features to clarify the independent prognostic role of gender in patients undergoing TAVI.…”

Incidence and prognosis of vascular complications after percutaneous placement of left ventricular assist device

“…This is probably related to the increased incidence of vascular complications in patients with smaller arteries. 29,30 None of the vascular complications in this study were attributed to thromboembolic events, and all originated from injury to the artery or occlusion from the large cannula. Patients in shock and on inotropic support also showed a significantly higher incidence of limb ischemia, probably because they were hypoperfused to begin with, and as may be expected, the Impella device was placed for a longer time.…”

Impact of Aortic Annulus Size on Valve Hemodynamics and Clinical Outcomes After Transcatheter and Surgical Aortic Valve Replacement

“…Several previous studies including a recent meta-analysis have suggested better results of TAVR in women, but no clear explanation was found for this sex paradox in the TAVR field. [20][21][22] Female sex is usually associated with smaller aortic annulus, and this study provides further insight into the potential advantages of having a small aortic annulus when receiving a transcatheter valve. On the contrary, a negative impact has been associated with female sex in patients undergoing cardiac surgery including aortic valve replacement in elderly patients.…”