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Elbaz-Greener G, Rahamim E, Abu Ghosh Z, Shadafny N, Alcalai R, Korach A, Carasso S, Wijeysundera HC, Igor T, Amir O, Rozen G, Planer D. Sex difference and outcome trends following surgical aortic valve replacement from the National Inpatient Sample (NIS) Database. THE JOURNAL OF CARDIOVASCULAR SURGERY 2024; 65:161-168. [PMID: 38332715 DOI: 10.23736/s0021-9509.23.12729-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
BACKGROUND Based on worldwide registries, approximately 50% of patients who underwent aortic valve replacement (AVR) via surgical aortic valve replacement are females. Although AVR procedures have improved greatly in recent years, differences in outcome including mortality between sexes remain. We aimed to investigate the trends in SAVR outcomes in females versus males. METHODS Using the 2011-2017 National Inpatient Sample (NIS) database, we identified hospitalizations for patients with diagnosis of aortic stenosis during which SAVR was performed. Patients' sociodemographic and clinical characteristics, procedure complications, and mortality were analyzed. Piecewise regression analyses were performed to assess temporal trends in SAVR utilization in females versus males. Multivariable analyses were performed to identify predictors of in-hospital mortality. RESULTS A total of 392,087 hospitalizations for SAVR across the USA were analyzed. Utilization of SAVR in both sex patients decreased significantly during the years 2011-2017. Males compared to females had significantly higher rates of hyperlipidemia, chronic renal disease, peripheral artery disease, coronary artery disease and tended to be smokers. Differences in mortality rates among sexes were observed for SAVR procedures. Women had higher in-hospital mortality with 3.7% compared to men with 2.5% (OR 1.38 [95% CI 1.33-1.43, P<0.001]). In a multivariable regression model analysis adjusted for potential confounders, women had higher mortality risk with odd ratio (OR 1.38 [95% CI 1.33-1.43], P<0.001). Women had significantly higher rates of vascular complications (5.1% compared to men with 4.6%, P=0.002). CONCLUSIONS Utilization of SAVR showed a downward trend during the study period. Higher in-hospital mortality was recorded in females compared to males.
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Affiliation(s)
- Gabby Elbaz-Greener
- Department of Cardiology, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel -
| | - Eldad Rahamim
- Department of Cardiology, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Zahi Abu Ghosh
- Department of Cardiology, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Naseem Shadafny
- Department of Cardiology, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ronny Alcalai
- Department of Cardiology, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Amit Korach
- Department of Cardiac Surgery, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Shemy Carasso
- The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
- Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Harindra C Wijeysundera
- Schulich Heart Centre, Division of Cardiology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Tomas Igor
- Institute for Cardiovascular Disease of Vojvodina, Belgrade, Serbia
| | - Offer Amir
- Department of Cardiology, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Guy Rozen
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Tufts University School of Medicine, Boston, MA, USA
| | - David Planer
- Department of Cardiology, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Rashedi N, Otto CM. Treatment of Severe Aortic Valve Stenosis: Impact of Patient Sex and Life Expectancy on Treatment Choice. Eur Cardiol 2022; 17:e25. [PMID: 36845216 PMCID: PMC9947935 DOI: 10.15420/ecr.2022.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 09/10/2022] [Indexed: 12/14/2022] Open
Abstract
In adults with severe aortic stenosis, sex and age differences in symptoms and diagnosis may lead to delays in intervention. Choice of intervention partly depends on expected longevity because bioprosthetic valves have limited durability, particularly in younger patients. Current guidelines recommend the following: a mechanical valve in younger adults (aged <50 years) if lifelong anticoagulation is possible and acceptable and a valve-sparing procedure is not possible; surgical mechanical or bioprosthetic aortic valve replacement (SAVR) in adults aged 50-65 years; and transcatheter aortic valve implantation (TAVI) for those aged >80 years based on lower mortality and morbidity compared to SAVR and adequate valve durability. For patients aged 65-80 years, the choice between TAVI and a bioprosthetic SAVR depends on expected longevity, which is greater in women than men, as well as associated cardiac and noncardiac conditions, valvular and vascular anatomy, estimated risk of SAVR versus TAVI and expected complications and patient preferences.
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Affiliation(s)
- Nina Rashedi
- Division of Cardiology, University of Washington School of MedicineSeattle, WA, US
| | - Catherine M Otto
- Division of Cardiology, University of Washington School of MedicineSeattle, WA, US
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Elbaz-Greener G, Rahamim E, Abu Ghosh Z, Carasso S, Yarkoni M, Radhakrishnan S, Wijeysundera HC, Igor T, Planer D, Rozen G, Amir O. Sex difference and outcome trends following transcatheter aortic valve replacement. Front Cardiovasc Med 2022; 9:1013739. [PMID: 36329995 PMCID: PMC9623151 DOI: 10.3389/fcvm.2022.1013739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 09/08/2022] [Indexed: 01/09/2023] Open
Abstract
Background Based on worldwide registries, approximately 50% of patients who underwent transcatheter aortic valve replacement (TAVR) are female patients. Although TAVR procedures have improved tremendously in recent years, differences in outcome including mortality between sexes remain. We aimed to investigate the trends in TAVR in the early and new eras of utilization and to assess TAVR outcomes in female patients vs. male patients. Methods Using the 2011–2017 National Inpatient Sample (NIS) database, we identified hospitalizations for patients with the diagnosis of aortic stenosis during which a TAVR was performed. Patients' sociodemographic and clinical characteristics, procedure complications, and mortality were analyzed. Piecewise regression analyses were performed to assess temporal trends in TAVR utilization in female patients and in male patients. Multivariable analysis was performed to identify predictors of in-hospital mortality. Results A total of 150,647 hospitalizations for TAVR across the United States were analyzed during 2011–2017. During the study period, a steady upward trend was observed for TAVR procedures in both sexes. From 2011 to 2017, there were significantly more TAVR procedures performed in men [80,477 (53.4%)] than in women [70,170 (46.6%)]. Male patients had significantly higher Deyo-CCI score and comorbidities. Differences in mortality rates among sexes were observed, presenting with higher in-hospital mortality in women than in men, OR 1.26 [95% CI 1.18–1.35], p < 0.001. Conclusion Utilization of TAVR demonstrated a steady upward trend during 2011–2017, and a similar trend was presented for both sexes. Higher in-hospital mortality was recorded in female patients compared to male patients. Complication rates decreased over the years but without effect on mortality differences between the sex groups.
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Affiliation(s)
- Gabby Elbaz-Greener
- Department of Cardiology, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- *Correspondence: Gabby Elbaz-Greener
| | - Eldad Rahamim
- Department of Cardiology, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Zahi Abu Ghosh
- Department of Cardiology, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Shemy Carasso
- Division of Cardiovascular Medicine, Baruch Padeh Medical Center, Poria, Israel
- The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Merav Yarkoni
- Department of Cardiology, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sam Radhakrishnan
- Schulich Heart Program, Division of Cardiology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Harindra C. Wijeysundera
- Schulich Heart Program, Division of Cardiology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Tomas Igor
- Institute for Cardiovascular Disease of Vojvodina, Sremska Kamenica Institute, Belgrade, Serbia
| | - David Planer
- Department of Cardiology, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Guy Rozen
- Cardiovascular Center, Tufts Medical Center, Boston, MA, United States
- Tufts University School of Medicine, Boston, MA, United States
- Cardiac Arrhythmia Center, Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States
| | - Offer Amir
- Department of Cardiology, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
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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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Shishido K, Yamanaka F, Ochiai T, Moriyama N, Yokoyama H, Yokota S, Noguchi K, Yashima F, Tada N, Naganuma T, Araki M, Shirai S, Ueno H, Mizutani K, Tabata M, Takagi K, Watanabe Y, Yamamoto M, Saito S, Hayashida K. Effect of Sex on Mortality and Left Ventricular Remodeling After Transcatheter Aortic Valve Implantation. Circ J 2021; 85:979-988. [PMID: 33907051 DOI: 10.1253/circj.cj-20-1095] [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] [Indexed: 11/09/2022]
Abstract
BACKGROUND The effect of sex on mortality is controversial; furthermore, sex differences in left ventricular (LV) remodeling after transcatheter aortic valve implantation (TAVI) remain unknown.Methods and Results:This study included 2,588 patients (1,793 [69.3%] female) enrolled in the Optimized CathEter vAlvular iNtervention (OCEAN)-TAVI Japanese multicenter registry between October 2013 and May 2017. We retrospectively analyzed the effect of sex on mortality, and evaluated changes in the LV mass index (LVMI) after TAVI. Female sex was significantly associated with lower all-cause and cardiovascular mortality (log-rank P<0.001 for both). Multivariate analysis showed that female sex was independently associated with lower cumulative long-term mortality (hazard ratio 0.615; 95% confidence interval 0.512-0.738; P<0.001). Regression in the LVMI was observed in both sexes, and there was no significant difference in the percentage LVMI regression from baseline to 1 year after TAVI between women and men. Women had a survival advantage compared with men among patients with LVMI regression at 1 year, but not among patients with no LVMI regression. CONCLUSIONS We found that female sex is associated with better survival outcomes after TAVI in a large Japanese registry. Although LVMI regression was observed in women and men after TAVI, post-procedural LV mass regression may be related to the sex differences in mortality.
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Affiliation(s)
- Koki Shishido
- Department of Cardiology, Shonan Kamakura General Hospital
| | | | - Tomoki Ochiai
- Department of Cardiology, Shonan Kamakura General Hospital
| | | | | | - Shohei Yokota
- Department of Cardiology, Shonan Kamakura General Hospital
| | - Kenichiro Noguchi
- Department of Cardiovascular Surgery, Shonan Kamakura General Hospital
| | | | - Norio Tada
- Department of Cardiology, Sendai Kousei Hospital
| | | | - Motoharu Araki
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital
| | | | - Hiroshi Ueno
- Department of Cardiovascular Medicine, Toyama University School of Medicine
| | - Kazuki Mizutani
- Department of Cardiovascular Medicine, Osaka City University School of Medicine
| | - Minoru Tabata
- Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center
| | | | - Yusuke Watanabe
- Department of Cardiology, Teikyo University School of Medicine
| | - Masanori Yamamoto
- Department of Cardiology, Toyohashi Heart Canter.,Department of Cardiology, Nagoya Heart Canter
| | - Shigeru Saito
- Department of Cardiology, Shonan Kamakura General Hospital
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Chikata Y, Iwata H, Doi S, Funamizu T, Okazaki S, Dohi S, Higuchi R, Saji M, Takamisawa I, Tamura H, Amano A, Daida H, Minamino T. Simultaneous Estimation of Gender Male and Atrial Fibrillation as Risk Factors for Adverse Outcomes Following Transcatheter Aortic Valve Implantation. J Clin Med 2020; 9:E3963. [PMID: 33297434 PMCID: PMC7762231 DOI: 10.3390/jcm9123963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 11/28/2020] [Accepted: 12/04/2020] [Indexed: 01/09/2023] Open
Abstract
Accurate outcome prediction following transcatheter aortic valve implantation (TAVI) has gained further importance along with expanding its indication to patients with a lower surgical risk. Although previous studies have evaluated the prognostic impacts of gender and atrial fibrillation (AF) in TAVI patients, these two factors have rarely been addressed simultaneously. This retrospective observational study based on a multicenter TAVI registry involved 1088 patients who underwent TAVI between May, 2010 and February, 2020 at 3 hospitals in Japan. Participants were divided into 4 groups by gender and pre-existing AF, such as Female AF(-) (n = 559), Male AF(-) (n = 266), Female AF(+) (n = 187) and Male AF(+) (n = 76). Primary and secondary endpoints were death due to any and cardiovascular cause, and the composite of all-cause death and heart failure hospitalization, respectively. The median follow-up period was 538 days. Cumulative incidences of primary and secondary endpoints were lower in the Female AF(-) group compared to the other 3 groups. Adjusted multivariate Cox proportional hazard analyses showed an independent association of either or both of male gender and AF with adverse outcomes, when compared to the group with none of these (hazard ratios and 95% confidence intervals vs. Female AF(-) (reference) for all-cause death of Male AF(-): 2.7, 1.6-4.6, p < 0.001, Female AF(+): 3.5, 2.1-6.0, p < 0.001, and Male AF(+): 3.9, 1.9-7.8, p < 0.001), while there was no evidence of their synergistic prognostic impact. Male gender and being complicated by AF independently, but not synergistically, predicted poor long-term outcomes in patients undergoing TAVI.
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Affiliation(s)
- Yuichi Chikata
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; (Y.C.); (S.D.); (T.F.); (S.O.); (H.D.); (T.M.)
| | - Hiroshi Iwata
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; (Y.C.); (S.D.); (T.F.); (S.O.); (H.D.); (T.M.)
| | - Shinichiro Doi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; (Y.C.); (S.D.); (T.F.); (S.O.); (H.D.); (T.M.)
| | - Takehiro Funamizu
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; (Y.C.); (S.D.); (T.F.); (S.O.); (H.D.); (T.M.)
| | - Shinya Okazaki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; (Y.C.); (S.D.); (T.F.); (S.O.); (H.D.); (T.M.)
| | - Shizuyuki Dohi
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; (S.D.); (A.A.)
| | - Ryosuke Higuchi
- Department of Cardiology, Sakakibara Heart Institute, Tokyo 183-0003, Japan; (R.H.); (M.S.); (I.T.)
| | - Mike Saji
- Department of Cardiology, Sakakibara Heart Institute, Tokyo 183-0003, Japan; (R.H.); (M.S.); (I.T.)
| | - Itaru Takamisawa
- Department of Cardiology, Sakakibara Heart Institute, Tokyo 183-0003, Japan; (R.H.); (M.S.); (I.T.)
| | - Harutoshi Tamura
- Department of Cardiology, Pulmonology and Nephrology, Yamagata University School of Medicine, Yamagata 990-9585, Japan;
| | - Atsushi Amano
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; (S.D.); (A.A.)
| | - Hiroyuki Daida
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; (Y.C.); (S.D.); (T.F.); (S.O.); (H.D.); (T.M.)
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; (Y.C.); (S.D.); (T.F.); (S.O.); (H.D.); (T.M.)
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Stehli J, Dagan M, Zaman S, Koh JQS, Quine E, Gouskova N, Crawford C, Dong M, Nanayakkara S, Htun NM, Stub D, Dick R, Walton A, Duffy SJ. Impact of Gender on Transcatheter Aortic Valve Implantation Outcomes. Am J Cardiol 2020; 133:98-104. [PMID: 32843145 DOI: 10.1016/j.amjcard.2020.07.052] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/16/2020] [Accepted: 07/17/2020] [Indexed: 10/23/2022]
Abstract
Previous studies indicate that women who underwentwho underwent transcatheter aortic valve implantation (TAVI) have poorer 30-day outcomes compared with men. However, the effect of gender as a prognostic factor for long-term outcomes following TAVI remains unclear. Between 2008 and 2018, all patients (n = 683) who underwent TAVI in 2 centres in Melbourne, Australia were prospectively included in a registry. The primary end-point was long-term mortality. The secondary end points were Valve Academic Research Consortium-2 (VARC-2) in-hospital complications and mortality at 30-days and 1-year. Of 683 patients, 328 (48%) were women. Women had a higher mean STS-PROM score (5.2 ± 3.1 vs 4.6 ± 3.5, p < 0.001) but less co-morbidities than men. Women had a significantly higher in-hospital bleeding rates (3.3% vs 1.0%, Odds Ratio 4.21, 95% confidence interval [CI] 1.16 to15.25, p = 0.027) and higher 30-day mortality (2.4% vs 0.3%, hazard ratio [HR] 8.75, 95% CI 1.09 to 69.6, p = 0.040) than men. Other VARC-2 outcomes were similar between genders. Overall mortality rate was 36% (246) over a median follow up of 2.7 (interquartile rang [IQR] 1.7 to 4.2) years. Median time to death was 5.3 (95% CI 4.7 to 5.7) years. One-year mortality was similar between genders (8.3% vs 7.8%), as was long-term mortality (HR = 0.91, 95% CI 0.71 to 1.17, p = 0.38). On multivariable analysis, female gender was an independent predictor for 1-year mortality (HR = 2.33, 95% CI 1.11 to 4.92, p = 0.026), but not long-term mortality (HR = 0.78, 95% CI 0.54 to 1.14, p = 0.20). In the women only cohort, STS-PROM was the only independent predictor of long-term mortality (HR 1.88, 95% CI 1.42 to 2.48, p < 0.001). In conclusion, women had higher rates of peri-procedural major bleeding and 30-day mortality following TAVI. However, long-term outcomes were similar between genders.
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Khan MZ, Zahid S, Khan MU, Khan SU, Munir MB, Balla S. Gender Disparities in Percutaneous Mitral Valve Repair (from the National Inpatient Sample). Am J Cardiol 2020; 132:179-181. [PMID: 32768141 DOI: 10.1016/j.amjcard.2020.07.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/07/2020] [Accepted: 07/13/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Muhammad Zia Khan
- Department of Medicine, West Virginia University, Morgantown, West Virginia.
| | - Salman Zahid
- Department of Medicine, Rochester General Hospital, Rochester, New York
| | - Muhammad U Khan
- Department of Medicine, West Virginia University, Morgantown, West Virginia
| | - Safi U Khan
- Department of Medicine, West Virginia University, Morgantown, West Virginia
| | - Muhammad Bilal Munir
- Division of Cardiovascular Medicine, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia; Division of Cardiovascular Medicine, University of California San Diego, La Jolla, California
| | - Sudarshan Balla
- Division of Cardiovascular Medicine, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia
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Goel R, Sartori S, Cao D, Claessen BE, Baber U, Chandiramani R, Nicolas J, Roumeliotis A, Power D, Chandrasekhar J, Tchetche D, Petronio AS, Mehilli J, Lefevre T, Presbitero P, Capranzano P, Iadanza A, Sardella G, Van Mieghem NM, Meliga E, Dumonteil N, Fraccaro C, Trabattoni D, Mikhail GW, Ferrer-Gracia MC, Naber C, Sharma S, Morice MC, Dangas GD, Chieffo A, Mehran R. Impact of diabetes mellitus on female subjects undergoing transcatheter aortic valve implantation: Insights from the WIN-TAVI international registry. Int J Cardiol 2020; 322:65-69. [PMID: 32814108 DOI: 10.1016/j.ijcard.2020.08.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/27/2020] [Accepted: 08/07/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Female subjects constitute half of all transcatheter aortic valve implantation (TAVI) candidates, but the association between important comorbidities such as diabetes mellitus (DM) and clinical outcomes after TAVI remains unclear in this group. METHOD WIN-TAVI is a real-world international registry of exclusively female subjects undergoing TAVI. The study population was stratified into those with (DM) and those without DM (NDM). Valve Academic Research Consortium (VARC)-2 efficacy (composite of all-cause death, stroke, myocardial infarction, hospitalization for valve-related symptoms or worsening congestive heart failure, or valve-related dysfunction) was the primary endpoint for this analysis. RESULTS Of the 1012 subjects included in this study, 264 (26.1%) had DM at baseline. DM patients were younger but had a higher burden of comorbidities. There were no differences in VARC-2 efficacy events between DM and NDM patients at 30 days or 1 year. Conversely, patients with DM had a lower risk of VARC-2 life threatening bleeding at 30 days and 1 year after TAVI compared to NDM patients, which remained significant even after multivariable adjustment (HR, 0.34, 95% CI, 0.12-0.99; p = .047). In the subgroup analysis, insulin-dependent DM was not associated with an increased risk of adverse outcomes. CONCLUSIONS Among female patients undergoing TAVI, more than one-fourth of the subjects presented with DM. At 1-year follow-up, DM was associated with lower bleeding complications and no increase in the risk of other adverse events, including mortality, after TAVI.
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Affiliation(s)
- Ridhima Goel
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Davide Cao
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Usman Baber
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Johny Nicolas
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - David Power
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | - Julinda Mehilli
- Munich University Clinic, Ludwig-Maximilians-University, German Centre for Cardiovascular Research, Munich Heart Alliance, Munich, Germany
| | - Thierry Lefevre
- Institut Hospitalier Jacques Cartier, Ramsay Générale de Santé, Massy, France
| | | | | | | | - Gennaro Sardella
- Policlinico "Umberto I", Sapienza University of Rome, Rome, Italy
| | | | | | | | | | | | - Ghada W Mikhail
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | | | - Christoph Naber
- Contilia Heart and Vascular Centre, Elisabeth Krankenhaus, Essen, Germany
| | - Samin Sharma
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Marie-Claude Morice
- Institut Hospitalier Jacques Cartier, Ramsay Générale de Santé, Massy, France
| | | | | | - Roxana Mehran
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Benamer H, Saighi Bouaouina M, Sanguineti F, Neylon A, Garot P, Hovasse T, Unterseeh T, Champagne S, Lefèvre T, Chevalier B. [TAVI in women, very encouraging results]. Ann Cardiol Angeiol (Paris) 2019; 68:429-433. [PMID: 31668338 DOI: 10.1016/j.ancard.2019.09.018] [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: 09/13/2019] [Accepted: 09/20/2019] [Indexed: 11/16/2022]
Abstract
The population of elderly patients comprises a high percentage of women. This population is more vulnerable due to the presence of numerous comorbidities and is, therefore, particularly exposed to the risk of aortic valve degeneration, resulting in aortic valve stenosis whose symptoms are predictors of poor short-term outcomes. In the presence of symptomatic aortic stenosis, the recommended therapeutic option in this vulnerable population is the implementation of transcatheter aortic valve implantation, preferably via the femoral route. The outcomes of this procedure are better in women than in men despite a more frequent occurrence of vascular, bleeding and cerebral complications. Several hypotheses have been reported in the literature regarding the reasons for such differences. Among other reasons, it is likely that in female patients, the myocardium adjusts better to the occurrence of aortic stenosis and that recovery after valve treatment is also more optimal. Another explanation is the higher frequency of coronary artery disease in this older population. This has a considerable impact on the outcome even when coronary lesions are treated prior to valve implantation. There is still room for improvement and progress can be achieved by further reducing the size of the equipment used in order to decrease the diameter of the vascular access, and by continuing to simplify TAVI procedures. Less invasive techniques should result in decreased complication rates. In addition, dedicated studies should allow us to further improve our practice in this growing population of vulnerable patients.
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Affiliation(s)
- H Benamer
- ICPS Jacques-Cartier, Ramsay générale de santé, 6, avenue du Noyer-Lambert, 91300 Massy, France; ICV-GVM La Roseraie, 120, avenue de la République, 93300 Aubervilliers, France; Hôpital Foch, Suresnes, France.
| | - M Saighi Bouaouina
- ICV-GVM La Roseraie, 120, avenue de la République, 93300 Aubervilliers, France; Hôpital Foch, Suresnes, France
| | - F Sanguineti
- ICPS Jacques-Cartier, Ramsay générale de santé, 6, avenue du Noyer-Lambert, 91300 Massy, France; Hôpital Claude-Gallien, 91480 Quincy-sous-Sénart, France
| | - A Neylon
- ICPS Jacques-Cartier, Ramsay générale de santé, 6, avenue du Noyer-Lambert, 91300 Massy, France; Hôpital Claude-Gallien, 91480 Quincy-sous-Sénart, France
| | - P Garot
- ICPS Jacques-Cartier, Ramsay générale de santé, 6, avenue du Noyer-Lambert, 91300 Massy, France; Hôpital Claude-Gallien, 91480 Quincy-sous-Sénart, France
| | - T Hovasse
- ICPS Jacques-Cartier, Ramsay générale de santé, 6, avenue du Noyer-Lambert, 91300 Massy, France; Hôpital Claude-Gallien, 91480 Quincy-sous-Sénart, France
| | - T Unterseeh
- ICPS Jacques-Cartier, Ramsay générale de santé, 6, avenue du Noyer-Lambert, 91300 Massy, France; Hôpital Claude-Gallien, 91480 Quincy-sous-Sénart, France
| | - S Champagne
- ICPS Jacques-Cartier, Ramsay générale de santé, 6, avenue du Noyer-Lambert, 91300 Massy, France; Hôpital Claude-Gallien, 91480 Quincy-sous-Sénart, France
| | - T Lefèvre
- ICPS Jacques-Cartier, Ramsay générale de santé, 6, avenue du Noyer-Lambert, 91300 Massy, France; Hôpital Claude-Gallien, 91480 Quincy-sous-Sénart, France
| | - B Chevalier
- ICPS Jacques-Cartier, Ramsay générale de santé, 6, avenue du Noyer-Lambert, 91300 Massy, France; Hôpital Claude-Gallien, 91480 Quincy-sous-Sénart, France
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Sex Differences in Transfemoral Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2019; 74:2758-2767. [PMID: 31562908 DOI: 10.1016/j.jacc.2019.09.015] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 09/12/2019] [Accepted: 09/13/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Transfemoral aortic valve replacement (TAVR) is a guideline-recommended treatment option for patients with severe aortic valve stenosis. Women and men present with different baseline characteristics, which may influence procedural outcomes. OBJECTIVES This study sought to evaluate differences between women and men undergoing transfemoral TAVR across the globe during the last decade. METHODS The CENTER (Cerebrovascular EveNts in patients undergoing TranscathetER aortic valve implantation with balloon-expandable valves versus self-expandable valves)-collaboration was a global patient level dataset of patients undergoing transfemoral TAVR (N = 12,381) from 2007 to 2018. In this retrospective analysis, the study examined differences in baseline patient characteristics, 30-day stroke and mortality, and in-hospital outcomes between female and male patients. The study also assessed for temporal changes in outcomes and predictors for mortality per sex. RESULTS We included 58% (n = 7,120) female and 42% (n = 5,261) male patients. Women had higher prevalence of hypertension and glomerular filtration rate <30 ml/min/1.73 m2 but lower prevalence of all other traditional cardiovascular comorbidities. Both sexes had similar rates of 30-day stroke (2.3% vs. 2.5%; p = 0.53) and mortality (5.9% vs. 5.5%; p = 0.17). In contrast, women had a 50% higher risk of life-threatening or major bleeding (6.7% vs. 4.4%; p < 0.01). Over the study period, mortality rates decreased to a greater extent in men than in women (60% vs. 50% reduction; both p < 0.001), with no reductions in stroke rates over time. CONCLUSIONS In this global collaboration, women and men had similar rates of 30-day mortality and stroke. However, women had higher rates of procedural life-threatening or major bleeding after TAVR. Between 2007 and 2018, mortality rates decreased to a greater extent in men than in women.
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