Sex-related differences in clinical presentation and outcome of transcatheter aortic valve implantation for severe aortic stenosis

Kentaro Hayashida, Marie Claude Morice, Bernard Chevalier, Thomas Hovasse, Mauro Romano, Philippe Garot, Arnaud Farge, Patrick Donzeau-Gouge, Erik Bouvier, Bertrand Cormier, Thierry Lefvre

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Abstract

Objectives: The purpose of this study was to clarify the impact of sex-related differences in transcatheter aortic valve implantation (TAVI) for high-risk patients with severe aortic stenosis. Background: Although TAVI is becoming a mature technique, the impact of sex differences remains unclear. Methods: The TAVI patients were included prospectively in a dedicated database from October 2006. The proportion of women (n = 131) was similar to that of men (n = 129). The Edwards valve (85.4%) and CoreValve (14.6%) were used through the transfemoral (65.0%), subclavian (3.1%), or transapical (31.9%) approach. All events were defined according to Valve Academic Research Consortium criteria. Results: Age was similar (83.1 ± 6.3 years), but women had less coronary and peripheral disease, less previous cardiac surgery, higher ejection fraction, and lower EuroSCORE (European System for Cardiac Operative Risk Evaluation [22.3 ± 9.0% vs. 26.2 ± 13.0%, p = 0.005]). Minimal femoral size (7.74 ± 1.03 mm vs. 8.55 ± 1.34 mm, p < 0.001), annulus size (20.9 ± 1.4 vs. 22.9 ± 1.7 mm, p < 0.001), and valve size (23.9 ± 1.6 mm vs. 26.3 ± 1.5 mm, p < 0.001) were smaller in women. Device success was similar (90.8% vs. 88.4%, p = 0.516) despite more frequent iliac complications (9.0% vs. 2.5%, p = 0.030). Residual mean aortic pressure gradient (11.6 ± 4.9 vs. 10.9 ± 4.9, p = 0.279) was also similar. The 1-year survival rate was higher for women, 76% (95% confidence interval: 72% to 80%), than for men, 65% (95% confidence interval: 60% to 69%); and male sex (hazard ratio: 1.62, 95% confidence interval: 1.03 to 2.53, p = 0.037) was identified as a predictor of midterm mortality by Cox regression analysis. Conclusions: Female sex is associated with better baseline clinical characteristics and improved survival, and is identified as a predictor of midterm survival after TAVI.

Original languageEnglish
Pages (from-to)566-571
Number of pages6
JournalJournal of the American College of Cardiology
Volume59
Issue number6
DOIs
Publication statusPublished - 2012 Feb 7

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Keywords

  • Valve Academic Research Consortium
  • aortic stenosis
  • mortality
  • sex differences
  • transcatheter aortic valve implantation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Hayashida, K., Morice, M. C., Chevalier, B., Hovasse, T., Romano, M., Garot, P., Farge, A., Donzeau-Gouge, P., Bouvier, E., Cormier, B., & Lefvre, T. (2012). Sex-related differences in clinical presentation and outcome of transcatheter aortic valve implantation for severe aortic stenosis. Journal of the American College of Cardiology, 59(6), 566-571. https://doi.org/10.1016/j.jacc.2011.10.877