Comparison in Men Versus Women of Co-morbidities, Complications, and Outcomes After Transcatheter Aortic Valve Implantation for Severe Aortic Stenosis.
Transcatheter aortic valve implantation (TAVI) decreases mortality in high-risk patients with severe aortic stenosis, but it remains unclear if female gender is associated with more favorable outcomes after TAVI. All patients who underwent TAVI at a single institution were retrospectively analyzed and stratified by gender. Procedural, in-hospital, 30-day, and 1-year outcomes were defined according to the second Valve Academic Research Consortium. The primary end point was all-cause mortality at 1 year. Kaplan-Meier survival analysis and multivariable Cox proportional hazards regression were conducted. Overall, 755 patients underwent TAVI and were included in the study; 50.7% were women. Average age was 83.0 ± 7.7 years, with a mean Society of Thoracic Surgeons score of 8.9 ± 4.6. Women were older than men and more likely to be black. Most co-morbidities were less common among women, and they were more likely than men to suffer both in-hospital (8.4% vs 4.3%, p = 0.021) and 30-day (9.4% vs 5.4%, p = 0.035) all-cause mortality. Life-threatening bleeding, transfusion, and iliofemoral dissection or perforation were more common among women. There was no difference in mortality between women and men at 1 year (20.6% vs 21.5%, log-rank p = 0.87). After multivariable adjustment, however, female gender was independently associated with lower mortality at 1 year after TAVI. In conclusion, despite higher rates of major bleeding, vascular complications, and 30-day mortality, female gender was independently associated with improved survival at 1 year after TAVI.
Section of Interventional Cardiology, Division of Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia. Electronic address: michael.a.gaglia@medstar.net.
Michael A
MA
Gaglia
Section of Interventional Cardiology, Division of Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia.
Michael J
MJ
Lipinski
Section of Interventional Cardiology, Division of Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia.
Rebecca
R
Torguson
Section of Interventional Cardiology, Division of Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia.
Jiaxiang
J
Gai
Section of Interventional Cardiology, Division of Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia.
Itsik
I
Ben-Dor
Section of Interventional Cardiology, Division of Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia.
Nelson L
NL
Bernardo
Section of Interventional Cardiology, Division of Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia.
Lowell F
LF
Satler
Section of Interventional Cardiology, Division of Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia.
Augusto D
AD
Pichard
Section of Interventional Cardiology, Division of Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia.
Ron
R
Waksman
D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D002423:Cause of Death / Q000639:trends; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000453:epidemiology*; D004219:District of Columbia / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D017678:Sex Distribution; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects*