1-Year Clinical Outcomes in Women After Transcatheter Aortic Valve Replacement

Chieffo, Alaide; Petronio, Anna Sonia; Mehilli, Julinda; Chandrasekhar, Jaya; Sartori, Samantha; Lefèvre, Thierry; Presbitero, Patrizia; Capranzano, Piera; Tchétché, Didier; Iadanza, Alessandro; Sardella, Gennaro; Mieghem, Nicolás M. Van; Meliga, Emanuele; Dumonteil, Nicholas; Fraccaro, Chiara; Trabattoni, Daniela; Mikhail, Ghada; Sharma, Samin K.; Ferrer, María Cruz; Naber, Christoph; Kievit, Peter C.; Baber, Usman; Snyder, Clayton; Sharma, Madhav; Morice, Marie Claude; Mehran, Roxana; Investigators, Win-Tavi

doi:10.1016/j.jcin.2017.09.034

Cited by 82 publications

(23 citation statements)

References 37 publications

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“…Prior coronary revascularisation (HR 1.72, 95% CI: 1.17-2.52; p=0.006) indicating established CAD and EuroSCORE I (HR 1.02, 95% CI: 1.00-1.04; p=0.027) were independent predictors of the VARC-2 efficacy endpoint. Of note, after adjustment, no significant association was observed between history of pregnancy or any sex-specific factors and one-year TAVR outcomes 38 . Finally, lower-risk patients are now a matter of debate and several trials are ongoing.…”

Section: Transcatheter Aortic Valve Implantationmentioning

confidence: 80%

Percutaneous coronary and structural interventions in women: a position statement from the EAPCI Women Committee

Chieffo

Mehilli²,

Capodanno³

et al. 2018

EuroIntervention

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Several expert documents on sex-based differences in interventional outcomes are now available, however this is the first position paper from the EAPCI Women Committee discussing the potential influence of sex in the percutaneous treatment of coronary and structural heart disease. Despite the misconception that coronary artery disease is a 'man's disease', contemporary data shows a growing incidence in women. However, women are under-represented in randomised coronary clinical trials (~25%). The generalisation of such studies is therefore problematic in decision-making for females undergoing coronary intervention. Differences in pathophysiology between sexes exist, highlighting the need for greater awareness amongst healthcare professionals to enable best evidence-based therapies for women as well as for men. Reassuringly, women represent half of the population included in transcatheter aortic valve implantation clinical trials and may actually benefit more. Growing evidence is also emerging for other interventional atrial procedures which may well be advantageous to women. Awareness of sex disparities is increasing, and we must all work collaboratively within our profession to ensure we provide effective care for all patients with heart disease. The EAPCI Women Committee aim to highlight such issues through this position paper and through visibility within the interventional community.

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Section: Transcatheter Aortic Valve Implantationmentioning

confidence: 80%

Percutaneous coronary and structural interventions in women: a position statement from the EAPCI Women Committee

Chieffo

Mehilli²,

Capodanno³

et al. 2018

EuroIntervention

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“…The Women’s International Transcatheter Aortic Valve Implantation (WIN-TAVI) Real-World Registry found that increasing age, history of prior stroke, left ventricular ejection fraction <30% and the generation of TAVI device deployed were all independent predictors of 30-day VARC-2 primary safety endpoint (a composite of all-cause mortality, stroke, major vascular complication, life-threatening bleeding, acute kidney injury, coronary artery obstruction and repeat procedure for valve-related dysfunction) in women. [48] In the effort to identify sex-specific factors that may influence outcomes, a history of pregnancy was found to be protective (OR 0.63). Age of menopause, history of osteoporosis and gynaecological or breast cancers seemed to have no influence on the primary safety endpoint.…”

Section: Gender-specific Analysismentioning

confidence: 99%

“…[29] The updated 1-year follow-up demonstrated a univariate but not multivariate protective association of previous history of pregnancy with 1-year incidence of death or stroke; also it failed to demonstrate any association with the VARC-2 composite efficacy endpoint beyond 30 days (a composite of all-cause mortality, all stroke, MI, hospitalisations for valve-related symptoms or worsening congestive heart failure or valve-related dysfunction). [48]…”

Section: Gender-specific Analysismentioning

confidence: 99%

Sex and Transcatheter Aortic Valve Implantation: Impact of Female Sex on Clinical Outcomes

et al. 2019

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Transcatheter aortic valve implantation (TAVI) has emerged as an alternative treatment for severe symptomatic aortic stenosis in patients who are not suitable for surgery or are at high surgical risk. Approximately 50% of patients undergoing TAVI are female and this is reflected by a higher inclusion rate of women in TAVI trials. However, women undergoing TAVI have different baseline clinical characteristics in comparison to men, with fewer comorbidities and a more preserved left ventricular ejection fraction. This translates into favourable outcomes after TAVI, despite a higher rate of peri-procedural complications. This article discusses gender differences in terms of presentation, procedural characteristics and post-procedural results in patients with aortic stenosis undergoing TAVI, with particular focus on possible sex-specific factors affecting outcome.

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“…Transcatheter aortic valve replacement (TAVR) has emerged as an effective treatment for aortic stenosis (AS) in moderate‐to‐high risk patients 1,2 . Despite significant advances in valve design and delivery techniques, TAVR remains associated with numerous complications such as paravalvular leak, stroke, and vascular access site bleeding 3‐5 . The majority of TAVR candidates are elderly patients with pre‐existing comorbidities that offset the procedure's long‐term prognosis 6 .…”

Section: Introductionmentioning

confidence: 99%

Preprocedural anemia in females undergoing transcatheter aortic valve implantation: Insights from the WIN‐TAVI registry

Nicolas

Claessen

Cao

et al. 2020

Cathet Cardio Intervent

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Objectives To assess the impact of anemia on clinical outcomes in female patients enrolled in the Women's InterNational transcatheter aortic valve implantation (WIN‐TAVI) registry. Background Anemia is highly prevalent among females who constitute half of TAVI candidates, yet, its clinical significance remains poorly investigated. Methods Patients were divided into three groups according to preprocedural hemoglobin (Hb) level: (1) no anemia (Hb ≥12 g/dl), (2) mild‐to‐moderate anemia (10 ≤ Hb <12 g/dl), and (3) severe anemia (Hb <10 g/dl). The primary outcome was the occurrence of Valve Academic Research Consortium (VARC)‐2 efficacy endpoint, a composite of mortality, stroke, myocardial infarction (MI), hospitalization for valve‐related symptoms or heart failure or valve‐related dysfunction at 1‐year follow‐up. Results Hemoglobin level was available in 877 (86.1%) patients: 412 (47.0%) had no anemia, 363 (41.4%) had mild‐to‐moderate anemia, and 102 (11.6%) had severe anemia. The latter group had a higher prevalence of cardiovascular risk factors. Compared with patients without anemia, severe anemia was associated with a greater risk of VARC‐2 efficacy endpoint (adjHR 1.71, 95% CI: 1.02–2.87, p = .04), all‐cause death (adjHR 2.36, 95% CI: 1.31–4.26, p = .004) and a composite of death, MI or stroke (adjHR 1.88, 95% CI: 1.10–3.22, p = .02) at 1 year. Moreover, an increased risk of late mortality (adjHR 1.15, 95% CI: 1.02–1.30, p = .03) was observed with every 1 g/dl decrease in hemoglobin level. Conclusion Severe anemia in females undergoing TAVI was independently associated with increased rates of VARC‐2 efficacy endpoint and mortality at 1 year.

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1-Year Clinical Outcomes in Women After Transcatheter Aortic Valve Replacement

Cited by 82 publications

References 37 publications

Percutaneous coronary and structural interventions in women: a position statement from the EAPCI Women Committee

Percutaneous coronary and structural interventions in women: a position statement from the EAPCI Women Committee

Sex and Transcatheter Aortic Valve Implantation: Impact of Female Sex on Clinical Outcomes

Preprocedural anemia in females undergoing transcatheter aortic valve implantation: Insights from the WIN‐TAVI registry

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