title: The Impact of Gender on Outcomes Following Transcatheter Aortic Valve Implantation: True Effect or Bias?
abstract: Transcatheter aortic valve implantation (TAVI) is currently the treatment of choice for patients with severe aortic stenosis (AS) who are unsuitable for surgical aortic valve replacement (SAVR), and is an acceptable alternative for those at high and intermediate surgical risk. In published TAVI registries and meta-analyses, whilst women are significantly older they present with fewer comorbidities compared to men (including coronary artery disease, peripheral vascular disease, diabetes and chronic obstructive pulmonary disease). In response to chronic pressure overload from AS, women have been shown to develop greater levels of left ventricular hypertrophy than men, as well as having a greater preservation of LV ejection fraction (LVEF) and less fibrosis. Following aortic valve replacement, women have been shown to have a faster regression of myocardial hypertrophy, with a significant improvement in LVEF. Following TAVI, female gender seems to be associated with a significantly lower one-year mortality. In the current viewpoint, it is discussed whether these findings reflect a true differential treatment response to TAVI among women, or simply the higher comorbidity burden among males undergoing TAVI.
authors.affiliation: Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK.|Cardiology Department, National Heart and Lung Institute, Imperial College London, London, UK. Electronic correspondence: v.panoulas@imperial.ac.uk.
authors.forename: Vasileios F
authors.initials: VF
authors.lastname: Panoulas
authors.affiliation: Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK.|Cardiology Department, National Heart and Lung Institute, Imperial College London, London, UK.
authors.forename: Neil
authors.initials: N
authors.lastname: Ruparelia
authors.affiliation: Cardiology Department, National Heart and Lung Institute, Imperial College London, London, UK.
authors.forename: Russel
authors.initials: R
authors.lastname: Franks
authors.affiliation: Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK.|Cardiology Department, National Heart and Lung Institute, Imperial College London, London, UK.
authors.forename: Sayan
authors.initials: S
authors.lastname: Sen
authors.affiliation: Radiology Department, National Heart and Lung Institute, Imperial College London, London, UK.
authors.forename: Ben
authors.initials: B
authors.lastname: Ariff
authors.affiliation: Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK.|Cardiology Department, National Heart and Lung Institute, Imperial College London, London, UK.
authors.forename: Nilesh
authors.initials: N
authors.lastname: Sutaria
authors.affiliation: Cardiology Department, National Heart and Lung Institute, Imperial College London, London, UK.
authors.forename: Angela
authors.initials: A
authors.lastname: Frame
authors.affiliation: Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK.|Cardiology Department, National Heart and Lung Institute, Imperial College London, London, UK.
authors.forename: Petros
authors.initials: P
authors.lastname: Nihoyannopoulos
authors.affiliation: Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK.|Cardiology Department, National Heart and Lung Institute, Imperial College London, London, UK.
authors.forename: Iqbal S
authors.initials: IS
authors.lastname: Malik
authors.affiliation: Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK.|Cardiology Department, National Heart and Lung Institute, Imperial College London, London, UK.
authors.forename: Ghada W
authors.initials: GW
authors.lastname: Mikhail
mesh_terms: D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D015897:Comorbidity; D006801:Humans; D008297:Male; D012307:Risk Factors; D012737:Sex Factors; D065467:Transcatheter Aortic Valve Replacement; D016896:Treatment Outcome