Sex differences in outcomes of transcatheter edge‐to‐edge repair with MitraClip: A meta‐analysis

Ya’qoub, Lina; Gad, Mohamed M.; Faza, Nadeen; Kunkel, Katherine; Ya’acoub, Rawan; Villablanca, Pedro A.; Bagur, Rodrigo; Alasnag, Mirvat; Eng, Marvin H.; Elgendy, Islam Y.

doi:10.1002/ccd.30110

Cited by 11 publications

(14 citation statements)

References 39 publications

(295 reference statements)

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“…Our findings are in line with prior studies for other transcatheter procedures. [17][18][19] Prior studies demonstrated sex differences in outcomes after TAVR using older devices. Women typically have smaller aortic annuli and a different clinical profile and comorbidities, like diabetes and hypertension, which could potentially influence clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…16 Women present for TAVR at an older age and generally have fewer comorbidities. 15,[17][18][19] Potential reasons for the older age of women undergoing TAVR could be delays in referral for TAVR, delays in seeking medical care due to other social commitment, or delays in the clinical presentation of aortic stenosis in women. [17][18][19] In addition, vascular problems, bleeding, and short-term mortality rates after TAVR have been reported to be higher in women than in males.…”

Section: Discussionmentioning

confidence: 99%

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Sex differences in the outcomes after transcatheter aortic valve replacement with newer generation devices: A meta‐analysis

El Sherbini,

Servito,

Zidan

et al. 2024

Cathet Cardio Intervent

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BackgroundTranscatheter aortic valve replacement (TAVR) is a reasonable therapeutic approach among patients with symptomatic severe aortic stenosis irrespective of surgical risk. Data regarding sex‐specific differences in the outcomes with newer generation valves are limited.MethodsElectronic databases were searched for studies assessing sex differences in the outcomes of patients undergoing TAVR with newer generation valves (SAPIEN 3 or Evolut). Random effects model was constructed for summary estimates.ResultsFour observational studies with 4522 patients (44.8% women) were included in the meta‐analysis. Women were older and had a lower prevalence of coronary artery disease and mean EuroScore. Women had a higher incidence of short‐term mortality (up to 30 days) (risk ratio [RR]: 1.60, 95% confidence interval [CI]: 1.14–2.25), but no difference in 1‐year mortality (RR: 0.92, 95% CI: 0.72–1.17). There was no significant difference in the incidence of major bleeding (RR: 1.16, 95% CI: 0.86–1.57), permanent pacemaker (PPM) (RR: 0.80, 95% CI: 0.62–1.04), or disabling stroke (RR: 1.16, 95% CI: 0.54–2.45).ConclusionIn this meta‐analysis, we found that women undergoing TAVR with newer‐generation devices were older but had a lower prevalence of comorbidities. Women had a higher incidence of short‐term mortality but no difference in the 1‐year mortality, bleeding, PPM, or stroke compared with men. Future studies are required to confirm these findings.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Sex differences in the outcomes after transcatheter aortic valve replacement with newer generation devices: A meta‐analysis

El Sherbini,

Servito,

Zidan

et al. 2024

Cathet Cardio Intervent

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“…An interesting finding of our analysis was that the sex-related benefit of TEER on survival was more prominent after 1-year of the procedure and the incidence of CV death after 1-year of TEER tended to be high in male as compared to female. The recent meta-analysis including 24905 patients undergoing TEER also demonstrated that female had a significantly lower incidence of all-cause death during long-term follow-up, while there was no difference in survival between male and female during short-term (up to 30-days of TEER) [11]. Among the predictor of long-term survival after TEER, the recent study demonstrated that residual MR severity ≤ 1+ and absence of left ventricular dilatation were associated with better clinical survival, and indeed, nearly 80% of both male and female obtained residual MR severity ≤ 1+ and male had higher proportion of left ventricular dilatation in our cohort [19].…”

Section: Discussionmentioning

confidence: 99%

“…While the previous registry data showed comparable prognosis between male and female after TEER, the recent meta-analysis shed light on the sex-related prognostic differences after TEER in that female had lower mortality on long-term follow-up than male [10,11]. Therefore, we sought to verify the impact of sex on long-term mortality after TEER for FMR using multicenter registry data.…”

Section: Introductionmentioning

confidence: 99%

Sex-specific difference of long-term mortality after transcatheter edge-to-edge repair for functional mitral regurgitation; Insights from the OCEAN-Mitral Registry

Hioki

Watanabe

Kataoka

et al. 2023

Preprint

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Background: Recent studies suggested short-term mortality after transcatheter edge-to-edge repair (TEER) was comparable between male and female. However, the sex-specific prognostic difference in long-term follow-up after TEER is still unknown. To evaluate the impact of sex on long-term mortality after TEER for functional mitral regurgitation (FMR) using multicenter registry data. Methods: We retrospectively analyzed 1220 patients (male 60.3%) who underwent TEER for FMR at 24 centers. Impact of sex on all-cause death and hospitalization for heart failure (HF) after TEER was evaluated using multivariate regression analysis and propensity score (PS) matching methods. Results: During the two-year follow-up, 205 all-cause death and 259 hospitalizations for HF were observed after TEER for FMR. Male had a significantly lower incidence of all-cause death than female (18.7% vs. 14.0%, log-rank p < 0.01). After adjustment by multivariate Cox-regression and PS matching, male was significantly associated with a higher incidence of all-cause mortality after TEER than female (hazard ratio [HR] 2.24, 95% confidence interval [CI] 1.48 to 3.39 in multivariate Cox-regression; HR 2.04, 95% CI 1.17 to 3.57 in PS matching). The sex-specific prognostic difference was even more pronounced after 1-year of TEER. On contrary, there was no sex-related difference in hospitalization for HF after TEER. Conclusions: Male had a higher incidence of two-year all-cause death during after TEER for FMR than female, while this was not observed in hospitalization for HF. This result might indicate that female with FMR is more likely to benefit from TEER for better prognosis.

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“…Instead data from the Society of Thoracic Surgery/ACC Transcatheter Valve Therapy registry (5.295 patients, 47.6% women enrolled from 2011 to 2017), have demonstrated sex differences in outcomes after TEER, with female sex associated with lower adjusted 1-year risk of all-cause mortality (45). Similarly a meta-analysis of eleven studies with a total of 24.905 patients (45.6% women) have reported that female sex is associated to lower adjusted mortality on long-term follow-up (46). Further studies are need to confirm sex differences in outcomes after transcatheter edge-to-edge repair (Fig.…”

Section: Mitral Valve Diseasementioning

confidence: 99%

Heart valve disease gender difference in the era of transcatether treatment

Aurigemma¹,

Burzotta²,

Trani³

2023

HVT

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Available data have demonstrated important sex-related differences in patients with valvular heart disease, regarding clinical presentation, treatment, and outcomes. Although the calcific aortic stenosis (AS) is more frequent in men compared to women, the majority of AS patients over 80 years old are women, in whom fibrotic remodeling of aortic valve is typically found. Mitral valve disease is more common in women. However females are under-referred or delayed referrals to treatment, probably due to the absence of sex-based LV dimension values guiding surgical timing. The development of transcatheter devices have revolutionized the treatment of valvular heart disease and increased the interest in this topic. In this context, the consideration of gender differences in presentation, diagnosis, treatment success, and prognosis is of great importance.

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Sex differences in outcomes of transcatheter edge‐to‐edge repair with MitraClip: A meta‐analysis

Cited by 11 publications

References 39 publications

Sex differences in the outcomes after transcatheter aortic valve replacement with newer generation devices: A meta‐analysis

Sex differences in the outcomes after transcatheter aortic valve replacement with newer generation devices: A meta‐analysis

Sex-specific difference of long-term mortality after transcatheter edge-to-edge repair for functional mitral regurgitation; Insights from the OCEAN-Mitral Registry

Heart valve disease gender difference in the era of transcatether treatment

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