title: Results differ between transaortic and open surgical aortic valve replacement in women.
abstract: BACKGROUND
  Despite the well-known impact of female sex on outcome after surgical aortic valve replacement (sAVR), few studies investigated its role after transcatheter aortic valve replacement (TAVR).
  
  
  METHODS
  After propensity-matching for age, baseline comorbidities, previous interventions, priority, frailty score, New York Heart Association class, left ventricular function and associated cardiac diseases, hospital mortality, and procedure-related morbidities of 388 women (194 TAVR versus 194 sAVR)-of 5,231 patients enrolled in 70 centers participating in this prospective multicenter national registry-were analyzed at a central management unit of the Italian National Institute of Health.
  
  
  RESULTS
  Although hospital mortality was comparable (4.1% TAVR versus 3.1% sAVR; p = 0.177), women undergoing sAVR showed a higher rate of transfusion (63.9% versus 37.1% TAVR; p = 0.0001); higher number of transfusions per patient (3.6 ± 0.4 versus 2.3 ± 0.3 TAVR; p = 0.049); a higher incidence of low cardiac output state (5.7% versus 3.6% TAVR; p = 0.017) and acute renal failure (8.8% versus 4.1% TAVR; p = 0.01); and higher mean transprosthetic gradients (15.7 ± 12.6 mm Hg versus 11.9 ± 10.7 mm Hg TAVR; p = 0.004). In contrast, women undergoing TAVR experienced significant postprocedural aortic regurgitation (mild, 37.6% versus 7.7% sAVR; moderate-to-severe, 7.1% versus 1.5% sAVR; p = 0.0001) and a higher rate of stroke (7.7% versus 2.5% sAVR; p = 0.037), major vascular complications (9.3% versus 0.5% sAVR; p = 0.0001), pacemaker implantation (12.4% versus 6.2% sAVR; p = 0.004), need for emergent percutaneous coronary intervention (1.0% versus 0% sAVR; p = 0.007), and longer intermediate care unit length of stay (2.5 ± 4.4 days versus 1.4 ± 2.6 days sAVR; p = 0.008). Perioperative myocardial infarction and lengths of intensive care unit stay and hospitalization were comparable (not significant).
  
  
  CONCLUSIONS
  Women undergoing sAVR and TAVR experienced different periprocedural morbidities. These data strongly suggest the need to strictly individualize the indications.
authors.affiliation: Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy. Electronic address: frankono@libero.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Onorati
authors.affiliation: National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: D'Errigo
authors.affiliation: Division of Cardiology, Ferrarotto Hospital, University of Catania, ETNA Foundation, Catania, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Barbanti
authors.affiliation: National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Rosato
authors.affiliation: IRCCS Department of Anesthesia & Intensive Care, San Raffaele Hospital, Milan, Italy.
authors.forename: Daniel Remo
authors.initials: DR
authors.lastname: Covello
authors.affiliation: National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy.
authors.forename: Alice
authors.initials: A
authors.lastname: Maraschini
authors.affiliation: Department of Cardiothoracic and Vascular Surgery and Anesthesia-ICU, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Ranucci
authors.affiliation: Department of Cardiovascular Surgery, S. Croce e Carle Hospital, Cuneo, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Grossi
authors.affiliation: Division of Cardiology, Careggi Hospital, Florence, Italy.
authors.forename: Gennaro
authors.initials: G
authors.lastname: Santoro
authors.affiliation: Division of Cardiology, Ferrarotto Hospital, University of Catania, ETNA Foundation, Catania, Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: Tamburino
authors.affiliation: Division of Cardiac Surgery, Ospedale San Martino University of Genoa Medical School, Genoa, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Santini
authors.affiliation: National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy.
authors.forename: Fulvia
authors.initials: F
authors.lastname: Seccareccia
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta; D001024:Aortic Valve Stenosis / Q000601:surgery*; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D057216:Propensity Score; D011446:Prospective Studies; D012737:Sex Factors
keywords: 35