Revisiting Sex Equality With Transcatheter Aortic Valve Replacement Outcomes

Abstract

Although women experience more bleeding events, as well as vascular and stroke complications, female sex is an independent predictor of late survival after transcatheter aortic valve replacement. This should be taken into account during patient selection for this procedure.

Sex Differences in the Utilization and Outcomes of Surgical Aortic Valve Replacement for Severe Aortic Stenosis

“…A large report from the ACC/TVT registry examined sex differences among 11 808 patients who underwent TAVR and found no difference in in‐hospital mortality in women versus men after TAVR but significantly better 1‐year mortality in women versus men (adjusted hazard ratio: 0.73; 95% CI, 0.63–0.85; P <0.001) 14. Similarly, in a patient‐level meta‐analysis including 11 310 patients, women had similar mortality to men at 30 days but had significantly better long‐term survival (adjusted hazard ratio: 0.79; 95% CI, 0.73–0.86; P =0.001), despite higher rates of in‐hospital complications 1. A subgroup analysis of the PARTNER trial showed that women who underwent TAVR had better short‐term (6.8% versus 13.1%; P =0.07) and long‐term (hazard ratio: 0.67; 95% CI, 0.44–1.0; P =0.049) mortality compared with women who underwent AVR 24.…”

“…The discussion of our findings would be incomplete without alluding to the emerging data demonstrating superior outcomes of TAVR in women compared with men and a higher magnitude of benefit of TAVR versus surgical AVR in women than in men 1, 14, 24, 33. A large report from the ACC/TVT registry examined sex differences among 11 808 patients who underwent TAVR and found no difference in in‐hospital mortality in women versus men after TAVR but significantly better 1‐year mortality in women versus men (adjusted hazard ratio: 0.73; 95% CI, 0.63–0.85; P <0.001) 14.…”

“…Sex‐related differences in the incidence, pathophysiology, presentation, treatment, and outcomes of cardiovascular diseases including aortic stenosis (AS) have been studied extensively 1. Aortic valve replacement (AVR) has historically been the gold standard treatment of calcific AS 2.…”

“…The interest in examining the sex gap in AS patients has been renewed with the introduction and widespread adoption of transcatheter AVR (TAVR). Recently, a report from the American College of Cardiology (ACC) and TVT registry and a large meta‐analysis showed superior outcomes with TAVR in women compared with men 1, 14. We hypothesized that female patients have worse outcomes following AVR compared with propensity‐matched male patients.…”

Interventional Cardiology

“…Although no differences were detected in survival to 30 days, female sex was independently associated with improved survival at a mean of 387 days. 70 Aortic annulus size and its relationship to outcome have also been assessed in patients having TAVR. In PARTNER A, patients with a small annulus who were assigned to surgery had a greater incidence of valve mismatch, effective aortic 71 This difference did not persist in the subsequent continued access registry, although an increased mortality rate was noted among patients with a large annulus in comparison with others.…”