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Springhetti P, Abdoun K, Clavel MA. Sex Differences in Aortic Stenosis: From the Pathophysiology to the Intervention, Current Challenges, and Future Perspectives. J Clin Med 2024; 13:4237. [PMID: 39064275 PMCID: PMC11278486 DOI: 10.3390/jcm13144237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 07/16/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024] Open
Abstract
Calcific aortic stenosis (AS) is a major cause of morbidity and mortality in high-income countries. AS presents sex-specific features impacting pathophysiology, outcomes, and management strategies. In women, AS often manifests with a high valvular fibrotic burden, small valvular annuli, concentric left ventricular (LV) remodeling/hypertrophy, and, frequently, supernormal LV ejection fraction coupled with diastolic dysfunction. Paradoxical low-flow low-gradient AS epitomizes these traits, posing significant challenges post-aortic valve replacement due to limited positive remodeling and significant risk of patient-prosthesis mismatch. Conversely, men present more commonly with LV dilatation and dysfunction, indicating the phenotype of classical low-flow low-gradient AS, i.e., with decreased LV ejection fraction. However, these distinctions have not been fully incorporated into guidelines for AS management. The only treatment for AS is aortic valve replacement; women are frequently referred late, leading to increased heart damage caused by AS. Therefore, it is important to reassess surgical planning and timing to minimize irreversible cardiac damage in women. The integrity and the consideration of sex differences in the management of AS is critical. Further research, including sufficient representation of women, is needed to investigate these differences and to develop individualized, sex-specific management strategies.
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Affiliation(s)
- Paolo Springhetti
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC G1V 4G5, Canada; (P.S.); (K.A.)
- Department of Medicine, Division of Cardiology, University of Verona, 37129 Verona, Italy
| | - Kathia Abdoun
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC G1V 4G5, Canada; (P.S.); (K.A.)
| | - Marie-Annick Clavel
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC G1V 4G5, Canada; (P.S.); (K.A.)
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Natalis A, Masson JB, Mansour MJ, Asmar MA, Potvin J, Gobeil JF, Riahi M, Noiseux N, Stevens LM, Forcillo J. Correlation between measured and predicted mismatch with valve hemodynamics in transcatheter aortic valve replacement: A sex-based analysis. Catheter Cardiovasc Interv 2023; 102:505-512. [PMID: 37449451 DOI: 10.1002/ccd.30764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 05/15/2023] [Accepted: 07/08/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Data regarding the reliability of predicted effective orifice area indexed (pEOAi) is scarce in transcatheter aortic valve replacement (TAVR). AIMS To assess the validity of the pEOAi in TAVR by correlating its value with echocardiography-derived hemodynamic data. METHODS A single-center retrospective cohort study of TAVR patients from 2012 to 2021 with available echocardiograms was conducted. Patient-prosthesis mismatch (PPM) was defined based on the Valve Academic Research Consortium 3 criteria. The main endpoints were the congruence of measured effective orifice area indexed (EOAi) and pEOAi with the hemodynamic data obtained by echocardiography. The secondary endpoint included a correlation of predicted PPM (pPPM) and measured PPM (mPPM) with postoperative New York Heart Association (NYHA) status. RESULTS A total of 318 patients were included. pPPM was more frequent than mPPM (54 [17%]; all moderate PPM vs. 39 [12.3%]: 32 moderate and 7 severe PPM). Predicted and measured EOAi were statistically correlated with postprocedural transvalvular mean gradient and Doppler velocity index (all p < 0.001), including in both sex-based subgroups. The positive predictive value and negative predictive value (NPV) of pPPM for postprocedural transvalvular mean gradient ≥ 20 mmHg were 16% and 97%, respectively. Only pPPM was significantly more prevalent in the group in which NYHA failed to improve than in those with symptom improvement (30.1% vs. 16%, p = 0.027). CONCLUSION Predicted PPM has an excellent NPV for postprocedural transvalvular mean gradient ≥ 20 mmHg and seems to be a good predictor of NYHA status evolution as opposed to measured PPM. Predicted EOAi can be used in procedural planning to reduce the risk of PPM in both TAVR male and female patients.
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Affiliation(s)
- Alexandre Natalis
- Centre Hospitalier Universitaire de Montréal (CHUM), Montréal, Quebec, Canada
| | - Jean-Bernard Masson
- Centre Hospitalier Universitaire de Montréal (CHUM), Montréal, Quebec, Canada
| | - Mohamad J Mansour
- Centre Hospitalier Universitaire de Montréal (CHUM), Montréal, Quebec, Canada
| | - Mike Al Asmar
- Centre Hospitalier Universitaire de Montréal (CHUM), Montréal, Quebec, Canada
| | - Jeannot Potvin
- Centre Hospitalier Universitaire de Montréal (CHUM), Montréal, Quebec, Canada
| | | | - Mounir Riahi
- Centre Hospitalier Universitaire de Montréal (CHUM), Montréal, Quebec, Canada
| | - Nicolas Noiseux
- Centre Hospitalier Universitaire de Montréal (CHUM), Montréal, Quebec, Canada
| | | | - Jessica Forcillo
- Centre Hospitalier Universitaire de Montréal (CHUM), Montréal, Quebec, Canada
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Trongtorsak A, Thangjui S, Adhikari P, Shrestha B, Kewcharoen J, Navaravong L, Kanjanauthai S, Attanasio S, Saudye HA. Gender Disparities after Transcatheter Aortic Valve Replacement with Newer Generation Transcatheter Heart Valves: A Systematic Review and Meta-Analysis. Med Sci (Basel) 2023; 11:medsci11020033. [PMID: 37218985 DOI: 10.3390/medsci11020033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 05/04/2023] [Accepted: 05/04/2023] [Indexed: 05/24/2023] Open
Abstract
Previous studies have demonstrated gender disparities in mortality and vascular complications after transcatheter aortic valve replacement (TAVR) with early generation transcatheter heart valves (THVs). It is unclear, however, whether gender-related differences persist with the newer generation THVs. We aim to assess gender disparities after TAVR with newer generation THVs. The MEDLINE and Embase databases were thoroughly searched from inception to April 2023 to identify studies that reported gender-specific outcomes after TAVR with newer generation THVs (Sapien 3, Corevalve Evolut R, and Evolut Pro). The outcomes of interest included 30-day mortality, 1-year mortality, and vascular complications. In total, 5 studies (4 databases) with a total of 47,933 patients (21,073 females and 26,860 males) were included. Ninety-six percent received TAVR via the transfemoral approach. The females had higher 30-day mortality rates (odds ratio (OR) = 1.53, 95% confidence interval (CI) 1.31-1.79, p-value (p) < 0.001) and vascular complications (OR = 1.43, 95% CI 1.23-1.65, p < 0.001). However, one-year mortality was similar between the two groups (OR = 0.78, 95% CI 0.61-1.00, p = 0.28). The female gender continues to be associated with higher 30-day mortality rates and vascular complications after TAVR with newer generation transcatheter heart valves, while there was no difference in 1-year mortality between the genders. More data is needed to explore the causes and whether we can improve TAVR outcomes in females.
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Affiliation(s)
- Angkawipa Trongtorsak
- Ascension Saint Francis Hospital, Internal Medicine Residency Program, Evanston, IL 60202, USA
| | - Sittinun Thangjui
- Bassett Healthcare Network, Internal Medicine Residency Program, New York, NY 13326, USA
| | - Pabitra Adhikari
- Ascension Saint Francis Hospital, Internal Medicine Residency Program, Evanston, IL 60202, USA
| | - Biraj Shrestha
- Reading Hospital-Tower Health, Internal Medicine Residency Program, West Reading, PA 19611, USA
| | - Jakrin Kewcharoen
- Division of Cardiovascular Medicine, Loma Linda University Health, Loma Linda, CA 92350, USA
| | - Leenhapong Navaravong
- Division of Cardiovascular Medicine, School of Medicine, University of Utah, Salt Lake City, UT 84112, USA
| | - Somsupha Kanjanauthai
- Division of Cardiovascular Medicine, University of Southern California, Los Angeles, CA 90007, USA
| | - Steve Attanasio
- Rush University Medical Center, Division of Cardiovascular Medicine, Chicago, IL 60612, USA
| | - Hammad A Saudye
- Ascension Saint Francis Hospital, Division of Cardiovascular Medicine, Evanston, IL 60202, USA
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Hartley A, Hammond-Haley M, Marshall DC, Salciccioli JD, Malik IS, Khamis RY, Shalhoub J. Trends in Mortality From Aortic Stenosis in Europe: 2000-2017. Front Cardiovasc Med 2021; 8:748137. [PMID: 34708094 PMCID: PMC8542896 DOI: 10.3389/fcvm.2021.748137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 09/15/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Trends in mortality from aortic stenosis across European countries are not well-understood, especially given the significant growth in transcatheter aortic valve implantation (TAVI) in the last 10 years. Methods: Age-standardised death rates were extracted from the World Health Organisation Mortality Database, using the International Classification of Diseases 10th edition code for non-rheumatic aortic stenosis for those aged > 45 years between 2000 and 2017. The UK and countries from the European Union with at least 1,000,000 inhabitants and at least 50% available datapoints over the study period were included: a total of 23 countries. Trends were described using Joinpoint regression analysis. Results: No reductions in mortality were demonstrated across all countries 2000-2017. Large increases in mortality were found for Croatia, Poland and Slovakia for both sexes (>300% change). Mortality plateaued in Germany from 2008 in females and 2012 in males, whilst mortality in the Netherlands declined for both sexes from 2007. Mortality differences between the sexes were observed, with greater mortality for males than females across most countries. Conclusions: Mortality from aortic stenosis has increased across Europe from 2000 to 2017. There are, however, sizable differences in mortality trends between Eastern and Western European countries. The need for health resource planning strategies to specifically target AS, particularly given the expected increase with ageing populations, is highlighted.
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Affiliation(s)
- Adam Hartley
- National Heart and Lung Institute, Imperial College London, London, United Kingdom,Imperial College Healthcare NHS Trust, London, United Kingdom,Department of Cardiology, Hammersmith Hospital, London, United Kingdom,*Correspondence: Adam Hartley
| | - Matthew Hammond-Haley
- British Heart Foundation Centre of Excellence, King's College London, London, United Kingdom
| | - Dominic C. Marshall
- National Heart and Lung Institute, Imperial College London, London, United Kingdom,Imperial College Healthcare NHS Trust, London, United Kingdom,Department of Respiratory Medicine, St Mary's Hospital, London, United Kingdom
| | - Justin D. Salciccioli
- Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Iqbal S. Malik
- Imperial College Healthcare NHS Trust, London, United Kingdom,Department of Cardiology, Hammersmith Hospital, London, United Kingdom
| | - Ramzi Y. Khamis
- National Heart and Lung Institute, Imperial College London, London, United Kingdom,Imperial College Healthcare NHS Trust, London, United Kingdom,Department of Cardiology, Hammersmith Hospital, London, United Kingdom
| | - Joseph Shalhoub
- Imperial College Healthcare NHS Trust, London, United Kingdom,Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, United Kingdom,Department of Vascular Surgery, St Mary's Hospital, London, United Kingdom
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Gender Differences after Transcatheter Aortic Valve Replacement (TAVR): Insights from the Italian Clinical Service Project. J Cardiovasc Dev Dis 2021; 8:jcdd8090114. [PMID: 34564131 PMCID: PMC8472227 DOI: 10.3390/jcdd8090114] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/07/2021] [Accepted: 09/09/2021] [Indexed: 11/29/2022] Open
Abstract
Background: TAVR is a safe alternative to surgical aortic valve replacement (SAVR); however, sex-related differences are still debated. This research aimed to examine gender differences in a real-world transcatheter aortic valve replacement (TAVR) cohort. Methods: All-comer aortic stenosis (AS) patients undergoing TAVR with a Medtronic valve across 19 Italian sites were prospectively included in the Italian Clinical Service Project (NCT01007474) between 2007 and 2019. The primary endpoint was 1-year mortality. We also investigated 3-year mortality, and ischemic and hemorrhagic endpoints, and we performed a propensity score matching to assemble patients with similar baseline characteristics. Results: Out of 3821 patients, 2149 (56.2%) women were enrolled. Compared with men, women were older (83 ± 6 vs. 81 ± 6 years, p < 0.001), more likely to present severe renal impairment (GFR ≤ 30 mL/min, 26.3% vs. 16.3%, p < 0.001) but had less previous cardiovascular events (all p < 0.001), with a higher mean Society of Thoracic Surgeons (STS) score (7.8% ± 7.1% vs. 7.2 ± 7.5, p < 0.001) and a greater mean aortic gradient (52.4 ± 15.3 vs. 47.3 ± 12.8 mmHg, p < 0.001). Transfemoral TAVR was performed more frequently in women (87.2% vs. 82.1%, p < 0.001), with a higher rate of major vascular complications and life-threatening bleeding (3.9% vs. 2.4%, p = 0.012 and 2.5% vs. 1.4%, p = 0.024). One-year mortality differed between female and male (11.5% vs. 15.0%, p = 0.002), and this difference persisted after adjustment for significant confounding variables (Adj.HR1yr 1.47, 95%IC 1.18–1.82, p < 0.001). Three-year mortality was also significantly lower in women compared with men (19.8% vs. 24.9%, p < 0.001) even after adjustment for age, STS score, eGFR, diabetes and severe COPD (Adj.HR3yr 1.42, 95%IC 1.21–1.68, p < 0.001). These results were confirmed in 689 pairs after propensity score matching. Conclusion: Despite higher rates of peri-procedural complications, women presented better survival than men. This better adaptive response to TAVR may be driven by sex-specific factors.
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Sex based analysis of the impact of red blood cell transfusion and vascular or bleeding complications related to TAVI - The TRITAVI-Women Study. Int J Cardiol 2021; 333:69-76. [PMID: 33662485 DOI: 10.1016/j.ijcard.2021.02.066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 02/19/2021] [Accepted: 02/22/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Women present specific risks for transcatheter aortic valve replacement (TAVI) but there are scarce sex-based analysis. The aim of this study was to explore the risk of vascular/bleeding complications in females vs. males that underwent TAVI and the impact of red blood cell (RBC) transfusion. METHODS TRITAVI-Women is a retrospective analysis in 13 European institutions. Propensity score based on pairs of different sex was performed and global outcomes, vascular/bleeding risk factors were determined. Afterwards, the female population of the study was divided into two groups according to the need of RBC transfusion and the risk for mortality, AKI, MI, stroke at 30-days and at 1-year were compared as a combined endpoint (primary endpoint) and separately (secondary endpoints). RESULTS The global study population included 5837 patients. Females presented more advanced NYHA class, chronic kidney disease, and baseline anemia. Vascular/bleeding complications and RBC transfusion were more common in women. However, 1-year mortality was lower for women in the matched cohort (8.1% vs.10.3%, p = 0.028). The need for RBC transfusion was an independent predictor of higher incidence of the primary endpoint at 30-day and 1-year. The main predictor of RBC transfusion in women was the presence of baseline anemia. CONCLUSIONS Women present lower risk of mortality than men at 1-year follow up, but not at 30-day due to higher rates of vascular/bleeding complications. RBC transfusion was also more often required in women and was an independent predictor or poorer outcomes. The treatment of pre-existing anemia before TAVI might improve the short-term results in women.
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Seoudy H, Lambers M, Winkler V, Dudlik L, Freitag-Wolf S, Frank J, Kuhn C, Rangrez AY, Puehler T, Lutter G, Bramlage P, Frey N, Frank D. Elevated high-sensitivity troponin T levels at 1-year follow-up are associated with increased long-term mortality after TAVR. Clin Res Cardiol 2021; 110:421-428. [PMID: 33098469 PMCID: PMC7907029 DOI: 10.1007/s00392-020-01759-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 10/05/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Elevated pre-procedural high-sensitivity troponin T (hs-TnT) levels predict adverse outcomes in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). It is unknown whether elevated troponin levels still provide prognostic information during follow-up after successful TAVR. We evaluated the long-term implications of elevated hs-TnT levels found at 1-year post-TAVR. METHODS AND RESULTS The study included 349 patients who underwent TAVR for severe AS from 2010-2019 and for whom 1-year hs-TnT levels were available. Any required percutaneous coronary interventions were performed > 1 week before TAVR. The primary endpoint was survival time starting at 1-year post-TAVR. Optimal hs-TnT cutoff for stratifying risk, identified by ROC analysis, was 39.4 pg/mL. 292 patients had hs-TnT < 39.4 pg/mL (median 18.3 pg/mL) and 57 had hs-TnT ≥ 39.4 pg/mL (median 51.2 pg/mL). The high hs-TnT group had a higher median N-terminal pro-B-type natriuretic peptide (NT-proBNP) level, greater left ventricular (LV) mass, higher prevalence of severe diastolic dysfunction, LV ejection fraction < 35%, severe renal dysfunction, and more men compared with the low hs-TnT group. All-cause mortality during follow-up after TAVR was significantly higher among patients who had hs-TnT ≥ 39.4 pg/mL compared with those who did not (mortality rate at 2 years post-TAVR: 12.3% vs. 4.1%, p = 0.010). Multivariate analysis identified 1-year hs-TnT ≥ 39.4 pg/mL (hazard ratio 2.93, 95% CI 1.91-4.49, p < 0.001), NT-proBNP level > 300 pg/mL, male sex, an eGFR < 60 mL/min/1.73 m2 and chronic obstructive pulmonary disease as independent risk factors for long-term mortality after TAVR. CONCLUSIONS Elevated hs-TnT concentrations at 1-year after TAVR were associated with a higher long-term mortality.
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Affiliation(s)
- Hatim Seoudy
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein Kiel, Arnold-Heller-Str.3, Haus K3, 24105 Kiel, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/ Kiel/ Lübeck, Kiel, Germany
| | - Moritz Lambers
- Department of Cardiology and Angiology, Contilia Heart and Vascular Centre Elisabeth-Krankenhaus, Essen, Germany
| | - Vincent Winkler
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein Kiel, Arnold-Heller-Str.3, Haus K3, 24105 Kiel, Germany
| | - Linnea Dudlik
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein Kiel, Arnold-Heller-Str.3, Haus K3, 24105 Kiel, Germany
| | - Sandra Freitag-Wolf
- Department of Medical Informatics and Statistics, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Johanne Frank
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein Kiel, Arnold-Heller-Str.3, Haus K3, 24105 Kiel, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/ Kiel/ Lübeck, Kiel, Germany
| | - Christian Kuhn
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein Kiel, Arnold-Heller-Str.3, Haus K3, 24105 Kiel, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/ Kiel/ Lübeck, Kiel, Germany
| | - Ashraf Yusuf Rangrez
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein Kiel, Arnold-Heller-Str.3, Haus K3, 24105 Kiel, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/ Kiel/ Lübeck, Kiel, Germany
| | - Thomas Puehler
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/ Kiel/ Lübeck, Kiel, Germany
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Georg Lutter
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/ Kiel/ Lübeck, Kiel, Germany
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Norbert Frey
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein Kiel, Arnold-Heller-Str.3, Haus K3, 24105 Kiel, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/ Kiel/ Lübeck, Kiel, Germany
| | - Derk Frank
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein Kiel, Arnold-Heller-Str.3, Haus K3, 24105 Kiel, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/ Kiel/ Lübeck, Kiel, Germany
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Bandyopadhyay D, Sartori S, Baber U, Cao D, Chandiramani R, Tchétché D, Petronio AS, Mehilli J, Lefèvre T, Presbitero P, Capranzaro P, Sardella G, Van Mieghem NM, Chandrasekhar J, Dumonteil N, Fraccaro C, Trabattoni D, Mikhail GW, Naber C, Kini A, Morice M, Claessen BE, Chieffo A, Mehran R. The impact of chronic kidney disease in women undergoing transcatheter aortic valve replacement: Analysis from the Women's INternational Transcatheter Aortic Valve Implantation (WIN‐TAVI) registry. Catheter Cardiovasc Interv 2020; 96:198-207. [DOI: 10.1002/ccd.28752] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 01/08/2020] [Accepted: 01/15/2020] [Indexed: 12/14/2022]
Affiliation(s)
| | - Samantha Sartori
- The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine at Mount Sinai New York New York
| | - Usman Baber
- The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine at Mount Sinai New York New York
| | - Davide Cao
- The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine at Mount Sinai New York New York
| | - Rishi Chandiramani
- The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine at Mount Sinai New York New York
| | | | | | - Julinda Mehilli
- Department of CardiologyLudwig‐Maximilians‐University of Munich Munich Germany
| | - Thierry Lefèvre
- Department of Cardiology, Institut Hospitalier Jacques CartierRamsay Générale de Santé Massy France
| | | | | | - Gennaro Sardella
- Department of CardiologyPoliclinico “Umberto I,” Sapienza University of Rome Rome Italy
| | | | - Jaya Chandrasekhar
- The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine at Mount Sinai New York New York
| | | | | | | | - Ghada W. Mikhail
- Department of CardiologyImperial College Healthcare NHS Trust, Hammersmith Hospital London UK
| | - Christoph Naber
- Department of Cardiology, Contilia Heart and Vascular CentreElisabeth‐Krankenhaus, Essen Essen Germany
| | - Annapoorna Kini
- The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine at Mount Sinai New York New York
| | - Marie‐Claude Morice
- Department of Cardiology, Institut Hospitalier Jacques CartierRamsay Générale de Santé Massy France
| | - Bimmer E. Claessen
- The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine at Mount Sinai New York New York
| | - Alaide Chieffo
- Department of CardiologySan Raffaele Scientific Institute Milan Italy
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine at Mount Sinai New York New York
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Ueshima D, Barioli A, Nai Fovino L, D'Amico G, Fabris T, Brener SJ, Tarantini G. The impact of pre‐existing peripheral artery disease on transcatheter aortic valve implantation outcomes: A systematic review and meta‐analysis. Catheter Cardiovasc Interv 2019; 95:993-1000. [DOI: 10.1002/ccd.28335] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 05/01/2019] [Indexed: 01/19/2023]
Affiliation(s)
- Daisuke Ueshima
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular SciencesUniversity of Padua Medical School Padua Italy
| | - Alberto Barioli
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular SciencesUniversity of Padua Medical School Padua Italy
| | - Luca Nai Fovino
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular SciencesUniversity of Padua Medical School Padua Italy
| | - Gianpiero D'Amico
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular SciencesUniversity of Padua Medical School Padua Italy
| | - Tommaso Fabris
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular SciencesUniversity of Padua Medical School Padua Italy
| | - Sorin J. Brener
- Department of Medicine, Cardiac Catheterization LaboratoryNew York‐Presbyterian Brooklyn Methodist Hospital Brooklyn New York
| | - Giuseppe Tarantini
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular SciencesUniversity of Padua Medical School Padua Italy
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Wang TY, Gracia E, Callahan S, Bilfinger T, Tannous H, Pyo R, Kort S, Skopicki H, Weinstein J, Patel N, Montellese D, Korlipara G, Khan S, Chikwe J, Parikh PB. Gender Disparities in Management and Outcomes Following Transcatheter Aortic Valve Implantation With Newer Generation Transcatheter Valves. Am J Cardiol 2019; 123:1489-1493. [PMID: 30782416 DOI: 10.1016/j.amjcard.2019.01.048] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 01/19/2019] [Accepted: 01/22/2019] [Indexed: 01/09/2023]
Abstract
The impact of gender on management and early outcomes after transcatheter aortic valve implantation (TAVI) in the setting of newer generation transcatheter heart valves (THVs) is not well known. We evaluated gender-specific differences on clinical management and in-hospital outcomes in adults who underwent TAVI with newer generation THVs. The study population included 298 consecutive patients who underwent TAVI and received a newer generation THV (Sapien 3 [Edwards Lifesciences, Irvine, California] or Corevalve Evolut R or Evolut Pro [Medtronic, Minneapolis, Minnesota]) from December 2015 to June 2018 at an academic tertiary medical center. Of the 298 patients, 154 (52%) were men and 144 (48%) were women. Compared with men, women were older, had lower serum creatinine, higher left ventricular ejection fraction, and lower rates of multiple co-morbidities, including previous coronary artery bypass graft surgery, previous myocardial infarction, and atrial fibrillation. Women were noted to have smaller aortic annular area and perimeter and underwent implantation of smaller THVs than men. At the time of discharge, women were more frequently prescribed a P2Y12 inhibitor (primarily clopidogrel) and less frequently prescribed oral anticoagulation (namely warfarin). Hospital length of stay and in-hospital rates of mortality, disabling stroke, and pacemaker were similar in men and women. In conclusion, in this observational prospective study of adults who underwent TAVI with newer generation THVs, while gender-related disparities in clinical presentation and procedural management were observed, no significant difference in clinical outcomes were noted in men and women. Further studies examining gender-related differences in procedural and postprocedural care after TAVI in the contemporary era are warranted to better understand and optimize clinical outcomes in both men and women.
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Affiliation(s)
- Ting-Yu Wang
- Division of Cardiovascular Medicine, Department of Medicine, State University of New York at Stony Brook, Stony Brook, New York
| | - Ely Gracia
- Division of Cardiovascular Medicine, Department of Medicine, State University of New York at Stony Brook, Stony Brook, New York
| | - Susan Callahan
- Division of Cardiothoracic Surgery, Department of Medicine, State University of New York at Stony Brook, Stony Brook, New York
| | - Thomas Bilfinger
- Division of Cardiothoracic Surgery, Department of Medicine, State University of New York at Stony Brook, Stony Brook, New York
| | - Henry Tannous
- Division of Cardiothoracic Surgery, Department of Medicine, State University of New York at Stony Brook, Stony Brook, New York
| | - Robert Pyo
- Division of Cardiovascular Medicine, Department of Medicine, State University of New York at Stony Brook, Stony Brook, New York
| | - Smadar Kort
- Division of Cardiovascular Medicine, Department of Medicine, State University of New York at Stony Brook, Stony Brook, New York
| | - Hal Skopicki
- Division of Cardiovascular Medicine, Department of Medicine, State University of New York at Stony Brook, Stony Brook, New York
| | - Jonathan Weinstein
- Division of Cardiovascular Medicine, Department of Medicine, State University of New York at Stony Brook, Stony Brook, New York
| | - Neal Patel
- Division of Cardiovascular Medicine, Department of Medicine, State University of New York at Stony Brook, Stony Brook, New York
| | - Daniel Montellese
- Division of Cardiovascular Medicine, Department of Medicine, State University of New York at Stony Brook, Stony Brook, New York
| | - Giridhar Korlipara
- Division of Cardiovascular Medicine, Department of Medicine, State University of New York at Stony Brook, Stony Brook, New York
| | - Shamim Khan
- Division of Cardiovascular Medicine, Department of Medicine, State University of New York at Stony Brook, Stony Brook, New York
| | - Joanna Chikwe
- Division of Cardiothoracic Surgery, Department of Medicine, State University of New York at Stony Brook, Stony Brook, New York
| | - Puja B Parikh
- Division of Cardiovascular Medicine, Department of Medicine, State University of New York at Stony Brook, Stony Brook, New York.
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11
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Besch G, Pili-Floury S, Morel C, Gilard M, Flicoteaux G, Salomon du Mont L, Perrotti A, Meneveau N, Chocron S, Schiele F, Le Breton H, Samain E, Chopard R. Impact of post-procedural glycemic variability on cardiovascular morbidity and mortality after transcatheter aortic valve implantation: a post hoc cohort analysis. Cardiovasc Diabetol 2019; 18:27. [PMID: 30857532 PMCID: PMC6410509 DOI: 10.1186/s12933-019-0831-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 02/19/2019] [Indexed: 12/28/2022] Open
Abstract
Background Glycemic variability is associated with worse outcomes after cardiac surgery, but the prognosis value of early glycemic variability after transcatheter aortic valve implantation is not known. This study was therefore designed to analyze the prognosis significance of post-procedural glycemic variability within 30 days after transcatheter aortic valve implantation. Methods A post hoc analysis of patients from our center included in the FRANCE and FRANCE-2 registries was conducted. Post-procedural glycemic variability was assessed by calculating the mean daily δ blood glucose during the first 2 days after transcatheter aortic valve implantation. Major complications within 30 days were death, stroke, myocardial infarction, acute heart failure, and life-threatening cardiac arrhythmias. Results We analyzed 160 patients (age (median [interquartile] = 84 [80–88] years; diabetes mellitus (n) = 41 (26%) patients; logistic Euroscore = 20 [12–32]). The median value of mean daily δ blood glucose was 4.3 mmol l−1. The rate of major complications within 30 days after procedure among patients with the lowest quartile of glycemic variability was 12%, increasing from 12 to 26%, and 39% in the second, third, and fourth quartiles, respectively. In multivariate analysis, glycemic variability was independently associated with an increased risk of major complications within 30 days after the procedure (odds ratio [95% CI] = 1.83 [1.19–2.83]; p = 0.006). Conclusions This study showed that post-procedural glycemic variability was associated with an increased risk of major complications within 30 days after transcatheter aortic valve implantation. Trial registration Clinical trial registration number https://www.clinicaltrials.gov/; identifier: NCT02726958; date: April 4th, 2016
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Affiliation(s)
- Guillaume Besch
- Department of Anesthesiology and Intensive Care, University Hospital of Besancon, 3 Boulevard Alexander Fleming, 25000, Besancon, France. .,EA3920, University of Franche-Comte, 25000, Besancon, France.
| | - Sebastien Pili-Floury
- Department of Anesthesiology and Intensive Care, University Hospital of Besancon, 3 Boulevard Alexander Fleming, 25000, Besancon, France.,EA3920, University of Franche-Comte, 25000, Besancon, France
| | - Caroline Morel
- Department of Anesthesiology and Intensive Care, University Hospital of Besancon, 3 Boulevard Alexander Fleming, 25000, Besancon, France
| | - Martine Gilard
- Department of Cardiology, University Hospital of Brest, 29609, Brest, France
| | - Guillaume Flicoteaux
- Department of Anesthesiology and Intensive Care, University Hospital of Besancon, 3 Boulevard Alexander Fleming, 25000, Besancon, France
| | - Lucie Salomon du Mont
- Department of Vascular Surgery, University Hospital of Besancon, 25000, Besancon, France
| | - Andrea Perrotti
- EA3920, University of Franche-Comte, 25000, Besancon, France.,Department of Cardiothoracic Surgery, University Hospital of Besancon, 25000, Besancon, France
| | - Nicolas Meneveau
- EA3920, University of Franche-Comte, 25000, Besancon, France.,Department of Cardiology, University Hospital of Besancon, 25000, Besancon, France
| | - Sidney Chocron
- EA3920, University of Franche-Comte, 25000, Besancon, France.,Department of Cardiothoracic Surgery, University Hospital of Besancon, 25000, Besancon, France
| | - Francois Schiele
- EA3920, University of Franche-Comte, 25000, Besancon, France.,Department of Cardiology, University Hospital of Besancon, 25000, Besancon, France
| | - Herve Le Breton
- Department of Cardiology and Vascular Diseases, University Hospital of Rennes, Rennes-1 University, LTSI, INSERM U1099, 35000, Rennes, France
| | - Emmanuel Samain
- Department of Anesthesiology and Intensive Care, University Hospital of Besancon, 3 Boulevard Alexander Fleming, 25000, Besancon, France.,EA3920, University of Franche-Comte, 25000, Besancon, France
| | - Romain Chopard
- EA3920, University of Franche-Comte, 25000, Besancon, France.,Department of Cardiology, University Hospital of Besancon, 25000, Besancon, France
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12
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Guedeney P, Chieffo A, Snyder C, Mehilli J, Petronio AS, Claessen BE, Sartori S, Lefèvre T, Presbitero P, Capranzano P, Tchétché D, Iadanza A, Sardella G, Van Mieghem NM, Chandrasekhar J, Vogel B, Sorrentino S, Kalkman DN, Meliga E, Dumonteil N, Fraccaro C, Trabattoni D, Mikhail G, Ferrer MC, Naber C, Kievit P, Baber U, Sharma S, Morice MC, Mehran R. Impact of Baseline Atrial Fibrillation on Outcomes Among Women Who Underwent Contemporary Transcatheter Aortic Valve Implantation (from the Win-TAVI Registry). Am J Cardiol 2018; 122:1909-1916. [PMID: 30318417 DOI: 10.1016/j.amjcard.2018.08.036] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 08/07/2018] [Accepted: 08/13/2018] [Indexed: 10/28/2022]
Abstract
Pre-existing atrial fibrillation (AF) is common among patients who underwent transcatheter aortic valve implantation (TAVI) and has been associated with adverse outcomes. The specific impact of AF at baseline in women who underwent TAVI, however, remains unknown. The Women's International Transcatheter Aortic Valve Implantation is a prospective, multinational registry evaluating the safety and performance of contemporary TAVI in women in 19 centers between January 2013 and December 2015. Patients with available electrocardiogram at baseline were compared according to the presence of AF. All events were adjudicated according to the Valve Academic Research Consortium 2 criteria. Associations between AF and outcomes were tested using multivariate Cox regression model. Of the 993 women with available baseline electrocardiogram included in the study, 200 (20.1%) presented with AF. Patients with AF at baseline had higher Euroscore I score values and more frequently had chronic kidney disease or prior stroke. Patients without AF more frequently had coronary artery disease. There was no difference regarding in-hospital events between the two groups aside from longer length of stay for patients with AF (13.3 ± 11 vs 11.5 ± 7.1 days, p = 0.01). In multivariate analysis, AF at baseline was associated with an increase of all-cause and cardiovascular death at 12 months (adjHR 1.67 95%CI 1.11 to 2.50, p = 0.013 and adjHR 1.85 95%CI 1.19 to 2.86, p = 0.006 respectively). In conclusion, in this prospective registry of women who underwent contemporary TAVI, the presence of AF at baseline was associated with significantly increased 12-month mortality.
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13
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El-Chilali K, Patsalis PC, Al-Rashid F, Kahlert HA, Riebisch M, Mincu RI, Totzeck M, Lind A, Jánosi RA, Kehren C, Dirkmann D, Peters J, Wendt D, Jakob H, Rassaf T, Kahlert P. Impact of baseline left ventricular ejection fraction on outcome after transfemoral transcatheter aortic valve implantation in patients with and without low-gradient aortic stenosis. Echocardiography 2018; 36:28-37. [PMID: 30484901 DOI: 10.1111/echo.14203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 10/10/2018] [Accepted: 11/01/2018] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES To evaluate the impact of baseline left ventricular ejection fraction (LVEF) and its interaction with low-gradient aortic stenosis (LGAS) on all-cause mortality after transfemoral aortic valve implantation (TF-TAVI). METHODS We reviewed mortality data of 624 consecutive single center TF-TAVI patients and categorized LVEF according to current ASE/EACVI recommendations (normal, mildly-, moderately-, and severely abnormal). RESULTS Baseline LVEF was normal in 336 (53.8%), mildly abnormal in 160 (25.6%), moderately abnormal in 91 (14.6%), and severely abnormal in 37 (5.9%) patients, and 1-year mortality was 19%, 17%, 23%, and 43% (P = 0.002), respectively. Patients with LGAS had a similar 1-year mortality compared to those without LGAS in groups with normal (19% vs 19%, P = 0.899) and mildly abnormal LVEF (16% vs 17%, P = 0.898). One-year mortality of patients with LGAS was significantly greater than in those without LGAS in presence of moderately abnormal LVEF (31% vs 11%, P = 0.022), and it was numerically greater than in those without LGAS in presence of severely abnormal LVEF (48% vs 25%, P = 0.219). In multivariate analysis, only the combination of moderately/severely abnormal LVEF and LGAS predicted increased 1-year mortality (HR: 2.12, 95% CI: 1.4-3.2, P < 0.001). Other variables, including EuroSCORE I did not affect this result. CONCLUSIONS Moderately/severely abnormal LVEF (≤40%) at baseline is associated with increased mortality after TF-TAVI, especially when the mean transvalvular aortic gradient is <40 mm Hg (LGAS), while outcomes in patients with normal and mildly abnormal LVEF are comparable regardless of the pressure gradient across the native aortic valve. (DRKS00013729).
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Affiliation(s)
- Karim El-Chilali
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, Essen University Hospital, Duisburg-Essen University, Essen, Germany
| | - Polykarpos Christos Patsalis
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, Essen University Hospital, Duisburg-Essen University, Essen, Germany
| | - Fadi Al-Rashid
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, Essen University Hospital, Duisburg-Essen University, Essen, Germany
| | - Heike Annelie Kahlert
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, Essen University Hospital, Duisburg-Essen University, Essen, Germany
| | - Matthias Riebisch
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, Essen University Hospital, Duisburg-Essen University, Essen, Germany
| | - Raluca-Ileana Mincu
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, Essen University Hospital, Duisburg-Essen University, Essen, Germany
| | - Matthias Totzeck
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, Essen University Hospital, Duisburg-Essen University, Essen, Germany
| | - Alexander Lind
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, Essen University Hospital, Duisburg-Essen University, Essen, Germany
| | - Rolf Alexander Jánosi
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, Essen University Hospital, Duisburg-Essen University, Essen, Germany
| | - Clemens Kehren
- Clinic for Anesthesiology and Intensive Care, Essen University Hospital, Duisburg-Essen University, Essen, Germany
| | - Daniel Dirkmann
- Clinic for Anesthesiology and Intensive Care, Essen University Hospital, Duisburg-Essen University, Essen, Germany
| | - Jürgen Peters
- Clinic for Anesthesiology and Intensive Care, Essen University Hospital, Duisburg-Essen University, Essen, Germany
| | - Daniel Wendt
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, Essen University Hospital, Duisburg-Essen University, Essen, Germany
| | - Heinz Jakob
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, Essen University Hospital, Duisburg-Essen University, Essen, Germany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, Essen University Hospital, Duisburg-Essen University, Essen, Germany
| | - Philipp Kahlert
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, Essen University Hospital, Duisburg-Essen University, Essen, Germany
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14
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Mihos CG, Klassen SL, Yucel E. Sex-Specific Considerations in Women with Aortic Stenosis and Outcomes After Transcatheter Aortic Valve Replacement. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:52. [PMID: 29923126 DOI: 10.1007/s11936-018-0651-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Aortic stenosis (AS) is the most common valvular disease in the elderly and is associated with poor outcomes. Transcatheter aortic valve replacement (TAVR) is an alternative to surgical aortic valve replacement (SAVR) in high-risk patients. Herein, we describe the gender-related differences in baseline characteristics and pathophysiologic response to severe AS, imaging considerations unique to females, and short- and long-term outcomes after TAVR. Women undergoing TAVR are older and frailer, have less cardiovascular comorbidities, smaller femoral artery size, better left ventricular systolic function, hypertrophied and small left ventricles leading to a higher incidence of paradoxical low-flow low-gradient AS, and a greater prevalence of porcelain aorta, smaller aortic annulus size, and lower coronary ostia heights. Imaging and histopathological data also suggests a sex-related myocardial response to pressure overload from AS. Women experience more vascular complications and blood transfusion requirements, serious procedural complications, and a greater incidence of stroke, but have better long-term outcomes than men. Patient-prosthesis mismatch, which is a concern in patients with a small aortic annulus size undergoing SAVR, has not been problematic with TAVR. The aforementioned findings suggest that TAVR may be preferable for women with severe AS. Further studies are warranted to directly compare TAVR with SAVR in women.
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Affiliation(s)
- Christos G Mihos
- Echocardiography Laboratory, Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL, USA
| | - Sheila L Klassen
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Yawkey 5B, Boston, MA, 02114, USA
| | - Evin Yucel
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Yawkey 5B, Boston, MA, 02114, USA.
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