Sex-related differences in outcomes after transcatheter aortic valve implantation: a systematic review and meta-analysis.
BACKGROUND
There were considerable discrepancies with regard to sex-related differences in complications and prognosis after transcatheter aortic valve implantation.


RESULTS
The Cochrane library and PubMed online databases were searched. Articles reporting sex-specific post-transcatheter aortic valve implantation complications and mortality were identified. Two authors selected studies and extracted data independently. Random- and fixed-effects models were used depending on between-study heterogeneity. There were 27 articles, a total of 9118 patients, enrolled in our systematic review and meta-analysis, including 4176 men and 4942 women. Pooled analyses suggested considerable sex-related differences in complications and early as well as midterm outcomes after transcatheter aortic valve implantation. The difference in the risk for heart block requiring permanent pacemaker implantation was noted to be significant only in the subgroup of the CoreValve-dominating studies (pooled risk ratio [RR, men versus women], 1.29; 95% confidence interval [CI], 1.13-1.47). Although men had significantly lower risks for major/life-threatening bleeding (pooled RR, 0.81; 95% CI, 0.68-0.96) and major vascular complications (pooled RR, 0.49; 95% CI, 0.37-0.66), they had poorer prognosis. In fact, male sex was associated with significantly higher risks for deaths at both 30 days (RR, 1.37; 95% CI, 1.07-1.76) and 1 year (RR, 1.30; 95% CI, 1.14-1.49).


CONCLUSIONS
Although men had lower risks for major/life-threatening bleeding and major vascular complications after transcatheter aortic valve implantation, they had less favorable short-term and midterm survival.
Department of Cardiology, West China Hospital, Sichuan University, Chengdu, PR China.
Zhen-Gang
ZG
Zhao
Yan-Biao
YB
Liao
Yong
Y
Peng
Hua
H
Chai
Wei
W
Liu
Qiao
Q
Li
Xin
X
Ren
Xue-Qin
XQ
Wang
Xiao-Lin
XL
Luo
Chen
C
Zhang
Li-Hui
LH
Lu
Qing-Tao
QT
Meng
Chi
C
Chen
Mao
M
Chen
Yuan
Y
Feng
De-Jia
DJ
Huang
D001021:Aortic Valve / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000401:mortality; D002407:Catheterization, Swan-Ganz; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D012306:Risk; D012737:Sex Factors; D016019:Survival Analysis; D016896:Treatment Outcome
aortic valve implantation; aortic valve stenosis; complication; outcome; sex characteristics; transcatheter