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

Research output: Contribution to journalArticle

122 Citations (Scopus)

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
Externally publishedYes

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Aortic Valve Stenosis
Sex Characteristics
Confidence Intervals
Survival
Sex Ratio
Thigh
Thoracic Surgery
Coronary Disease
Arterial Pressure
Survival Rate
Regression Analysis
Databases
Equipment and Supplies
Mortality
Transcatheter Aortic Valve Replacement
Research

Keywords

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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Sex-related differences in clinical presentation and outcome of transcatheter aortic valve implantation for severe aortic stenosis. / Hayashida, Kentaro; Morice, Marie Claude; Chevalier, Bernard; Hovasse, Thomas; Romano, Mauro; Garot, Philippe; Farge, Arnaud; Donzeau-Gouge, Patrick; Bouvier, Erik; Cormier, Bertrand; Lefvre, Thierry.

In: Journal of the American College of Cardiology, Vol. 59, No. 6, 07.02.2012, p. 566-571.

Research output: Contribution to journalArticle

Hayashida, K, Morice, MC, 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, vol. 59, no. 6, pp. 566-571. https://doi.org/10.1016/j.jacc.2011.10.877
Hayashida, Kentaro ; Morice, Marie Claude ; Chevalier, Bernard ; Hovasse, Thomas ; Romano, Mauro ; Garot, Philippe ; Farge, Arnaud ; Donzeau-Gouge, Patrick ; Bouvier, Erik ; Cormier, Bertrand ; Lefvre, Thierry. / Sex-related differences in clinical presentation and outcome of transcatheter aortic valve implantation for severe aortic stenosis. In: Journal of the American College of Cardiology. 2012 ; Vol. 59, No. 6. pp. 566-571.
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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.",
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AU - Hayashida, Kentaro

AU - Morice, Marie Claude

AU - Chevalier, Bernard

AU - Hovasse, Thomas

AU - Romano, Mauro

AU - Garot, Philippe

AU - Farge, Arnaud

AU - Donzeau-Gouge, Patrick

AU - Bouvier, Erik

AU - Cormier, Bertrand

AU - Lefvre, Thierry

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N2 - 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.

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KW - aortic stenosis

KW - mortality

KW - sex differences

KW - transcatheter aortic valve implantation

KW - Valve Academic Research Consortium

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