title: Sex differences in mortality after transcatheter aortic valve replacement for severe aortic stenosis.
abstract: OBJECTIVE
  The aim of this study was to examine sex differences in outcome after transcatheter aortic valve replacement (TAVR) with real-world data from 2 large centers in Canada.
  
  
  BACKGROUND
  Transcatheter aortic valve replacement is an effective alternative to surgical valve replacement in symptomatic patients with severe aortic stenosis, but the impact of sex on outcomes remains unclear. The PARTNER (Placement of Aortic Transcatheter Valves) 1A trial demonstrated greater benefit of TAVR over surgery in women, but whether this was due to the poorer surgical outcome of women or better TAVR outcome, compared with men, is unknown.
  
  
  METHODS
  Consecutive patients (n = 641) undergoing TAVR in Vancouver and Quebec City, Canada, were evaluated. Differences in all-cause mortality were examined with Kaplan-Meier estimates, adjusted logistic regression, and proportional hazards models.
  
  
  RESULTS
  Women comprised 51.3% of the cohort. Balloon-expandable valves were used in 97% of cases, with transapical approach in 51.7 % women and 38.1% men. Women had more major vascular complications (12.4% vs. 5.4%, p = 0.003) and borderline significantly more major/life-threatening bleeds (21.6% vs. 15.8%, p = 0.08). At baseline, women had higher aortic gradients and worse renal function but better ejection fractions. Men had more comorbidities: prior myocardial infarction, prior revascularization, and chronic obstructive pulmonary disease. The adjusted odds ratio for 30-day all-cause mortality favored women, 0.39 (95% confidence interval: 0.19 to 0.80; p = 0.01), and this benefit persisted for 2 years, hazard ratio 0.60 (95% confidence interval: 0.41 to 0.88; p = 0.008).
  
  
  CONCLUSIONS
  Female sex is associated with better short- and long-term survival after TAVR. Added to the PARTNER 1A findings, these results suggest TAVR might be the preferred treatment option for elderly women with symptomatic severe aortic stenosis.
authors: Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada. khumphries@providencehealth.bc.ca
authors: Karin H
authors: KH
authors: Humphries
authors: Stefan
authors: S
authors: Toggweiler
authors: Josep
authors: J
authors: Rodés-Cabau
authors: Luis
authors: L
authors: Nombela-Franco
authors: Eric
authors: E
authors: Dumont
authors: David A
authors: DA
authors: Wood
authors: Alexander B
authors: AB
authors: Willson
authors: Ronald K
authors: RK
authors: Binder
authors: Melanie
authors: M
authors: Freeman
authors: May K
authors: MK
authors: Lee
authors: Min
authors: M
authors: Gao
authors: Mona
authors: M
authors: Izadnegahdar
authors: Jian
authors: J
authors: Ye
authors: Anson
authors: A
authors: Cheung
authors: John G
authors: JG
authors: Webb
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000628:therapy*; D002170:Canada; D006328:Cardiac Catheterization; D002404:Catheterization; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000401:mortality*; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012720:Severity of Illness Index; D012737:Sex Factors; D013318:Stroke Volume; D016896:Treatment Outcome