Sex Differences in In-Hospital Outcomes of Transcatheter Aortic Valve Replacement

Amgai, Birendra; Chakraborty, Sanjoy; Bandyopadhyay, Dhrubajyoti; Gupta, Manasvi; Patel, Neelkumar; Hajra, Adrija; Dey, Amit; Koirala, Soniya; Ghosh, Raktim; Aronow, Wilbert S.; Kolte, Dhaval; Abbott, J. Dawn

doi:10.1016/j.cpcardiol.2020.100694

Cited by 9 publications

(17 citation statements)

References 31 publications

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“…A total of 28 16–43 studies were included that investigated the differences in outcomes between males and females undergoing TAVR. All included studies had a combined total of 156 275 patients with data collection dates ranging from 2004 to 2020.…”

Section: Resultsmentioning

confidence: 99%

Sex-Related Differences in Postoperative Outcomes After Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis

Bozso

EL‐Andari

Kang

et al. 2022

Cardiology in Review

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Aortic stenosis is the most common valvular disease of the heart and is increasing in prevalence. Previous literature has found inferior outcomes for females undergoing surgical aortic valve replacement, while recent investigations have found equivalent or superior outcomes for females undergoing transcatheter aortic valve replacement (TAVR). PubMed and Medline were systematically searched for articles published from January 1, 2010, to April 30, 2021, for retrospective and prospective studies comparing outcomes between males and females undergoing TAVR. One thousand one hundred eighty titles and abstracts were screened, and 28 were included in this review. Risk of bias was assessed using questions derived from the ROBINS-I tool and previous literature. The data were compiled and analyzed using the RevMan 5.4 software. The results of this review confirm the previously published literature and have found rates of acute kidney injury (P = 0.05) and postoperative pacemaker insertion (P < 0.00001) favoring females and in-hospital mortality (P = 0.04), stroke (P < 0.00001), bleeding complications (P < 0.00001), and vascular complications (P < 0.00001) favoring males. The previously published literature has demonstrated consistently inferior outcomes for females undergoing heart valve surgery when compared to males. However, contemporary literature investigating sex differences after TAVR has found comparable outcomes for females. While the postoperative outcomes after surgical aortic valve replacement and TAVR are well established, the causal factors are still unidentified. Future studies utilizing matching based on preoperative characteristics and follow-up including collection of postoperative ventricular remodeling and prosthetic valve performance data will aid in elucidating the causal factors impacting outcomes for males and females after TAVR.

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Section: Resultsmentioning

confidence: 99%

Sex-Related Differences in Postoperative Outcomes After Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis

Bozso

EL‐Andari

Kang

et al. 2022

Cardiology in Review

View full text Add to dashboard Cite

show abstract

“…Some studies have indicated worse 30-day mortality among women, largely due to increased bleeding and vascular complications. [6][7][8] In other studies, female sex has been demonstrated to be…”

mentioning

confidence: 75%

“…7 In contrast to these findings, a study of the National Inpatient Sample database from 2012 to 2015 with 61 239 patients found that women had increased in-hospital mortality following TAVR compared with men (adjusted odds ratio, 1.25 [95% CI, 1.01–1.54]). 6 With regard to long-term mortality, data from the Transcatheter Valve Therapy Registry included 23 652 patients and demonstrated lower 1-year mortality among women (adjusted hazard ratio, 0.73 [95% CI, 0.63–0.85]) compared with men 12 whereas a cohort of 683 patients in Australia who underwent TAVR showed that long-term mortality (up to 10 years) was similar between men and women. 35 In our study, we found no statistically significant difference in overall mortality for women compared with men in our study, although the direction of this effect was lower for women ( P =0.15).…”

Section: Discussionmentioning

confidence: 99%

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Sex Differences in the Impact of Aortic Valve Calcium Score on Mortality After Transcatheter Aortic Valve Replacement

Patel

Sabbagh

Johnson

et al. 2022

Circ: Cardiovascular Imaging

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BACKGROUND: Transcatheter aortic valve replacement (TAVR) is now an approved alternative to surgical aortic valve replacement for the treatment of severe aortic stenosis. As the clinical adoption of TAVR expands, it remains important to identify predictors of mortality after TAVR. We aimed to evaluate the impact of sex differences in aortic valve calcium score (AVCS) on long-term mortality following TAVR in a large patient sample. Methods: We included consecutive patients who successfully underwent TAVR for treatment of severe native aortic valve stenosis from June 2010 to May 2021 across all US Mayo Clinic sites with follow-up through July 2021. AVCS values were obtained from preoperative computed tomography of the chest. Additional clinical data were abstracted from medical records. Kaplan-Meier curves and Cox-proportional hazard regression models were employed to evaluate the effect of AVCS on long-term mortality. Results: A total of 2543 patients were evaluated in the final analysis. Forty-one percent were women, median age was 82 years (Q1: 76, Q3: 86), 18.4% received a permanent pacemaker following TAVR, and 88.5% received a balloon expandable valve. We demonstrate an increase in mortality risk with higher AVCS after multivariable adjustment ( P <0.001). When stratified by sex, every 500-unit increase in AVCS was associated with a 7% increase in mortality risk among women (adjusted hazard ratio, 1.07 [95% CI, 1.02–1.12]) but not in men. Conclusions: We demonstrate a notable sex difference in the association between AVCS and long-term mortality in a large TAVR patient sample. This study highlights the potential value of AVCS in preprocedural risk stratification, specifically among women undergoing TAVR. Additional studies are needed to validate this finding.

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“…A recent retrospective observational study suggested increased all-cause in-hospital mortality in females compared with males and increased in-hospital complications apart from acute kidney injury and permanent pacemaker implantation. 18 The influence of sex on differential short-term outcomes after TAVI warrants further study.…”

Section: Complicationsmentioning

confidence: 99%

Advances in transcatheter aortic valve implantation, part 2: perioperative care

2021

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Sex Differences in In-Hospital Outcomes of Transcatheter Aortic Valve Replacement

Cited by 9 publications

References 31 publications

Sex-Related Differences in Postoperative Outcomes After Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis

Sex-Related Differences in Postoperative Outcomes After Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis

Sex Differences in the Impact of Aortic Valve Calcium Score on Mortality After Transcatheter Aortic Valve Replacement

Advances in transcatheter aortic valve implantation, part 2: perioperative care

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