title: Sex differences in postprocedural aortic regurgitation and mid-term mortality after transcatheter aortic valve implantation.
abstract: BACKGROUND
  The impact of female sex on mortality after transcatheter aortic valve implantation (TAVI) is controversial. Post-procedural aortic regurgitation (AR) ≥ 2 has been associated with poor outcomes. Whether sex differences in post-procedural AR ≥ 2 could contribute to a mortality difference between women and men is not known.
  
  
  METHODS
  Six hundred fifty-six patients, women (53.1%), men (46.9%), with aortic stenosis underwent TAVI with the CoreValve system (92.8%) or the Edwards SAPIEN valve system (7.2%). AR was graded semiquantitatively as 0 = none, 1 = trivial, 2 = mild, 3 = moderate, and 4 = severe. The incidence of post-procedural AR ≥ 2 was reported.
  
  
  RESULTS
  Procedural success was similar in women as compared to men (97.9 vs 96.7%, P = 0.32). Post-procedural AR ≥ 2 occurred less frequently in women than in men (20.9 vs 29.6%, P = 0.01). After a median follow-up of 434 days, all-cause mortality tended to be lower in women than in men (20.7 vs 26.6%, logrank P = 0.10), and was significantly higher in patients with AR ≥ 2 than in those without (34.8 vs 19.7%, logrank P < 0.001). AR ≥ 2 [hazard ratio (HR) 1.73, 95% confidence interval (CI) 1.22-2.43, P = 0.002], but not female sex (P = 0.17) was an independent predictor of all-cause death at multivariable Cox regression. The predictive value of AR ≥ 2 was restricted to men (HR 2.96, P < 0.001 among men; HR 0.86, P = 0.60 among women; P for interaction = 0.002).
  
  
  CONCLUSIONS
  Women, as compared to men, present a trend toward lower mortality. A significant lower incidence of post-procedural AR ≥ 2 among women contributes to this finding. Female sex, however, was not a significant independent predictor of death.
authors.affiliation: Department of Interventional Cardiology, Istituto Clinico Humanitas IRCCS, Rozzano, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ferrante
authors.forename: Paolo
authors.initials: P
authors.lastname: Pagnotta
authors.forename: Anna Sonia
authors.initials: AS
authors.lastname: Petronio
authors.forename: Francesco
authors.initials: F
authors.lastname: Bedogni
authors.forename: Nedy
authors.initials: N
authors.lastname: Brambilla
authors.forename: Claudia
authors.initials: C
authors.lastname: Fiorina
authors.forename: Cristina
authors.initials: C
authors.lastname: Giannini
authors.forename: Marco
authors.initials: M
authors.lastname: Mennuni
authors.forename: Federico
authors.initials: F
authors.lastname: De Marco
authors.forename: Silvio
authors.initials: S
authors.lastname: Klugmann
authors.forename: Federica
authors.initials: F
authors.lastname: Ettori
authors.forename: Patrizia
authors.initials: P
authors.lastname: Presbitero
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D016009:Chi-Square Distribution; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D012042:Registries; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: aortic regurgitation; sex; transcatheter aortic valve implantation