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Dismorr M, Granbom-Koski M, Ellfors E, Rück A, Settergren M, Sartipy U, Glaser N. Sex differences and long-term clinical outcomes after transcatheter aortic valve replacement: A SWEDEHEART study. Am Heart J 2024; 277:27-38. [PMID: 39128658 DOI: 10.1016/j.ahj.2024.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 07/19/2024] [Accepted: 07/30/2024] [Indexed: 08/13/2024]
Abstract
BACKGROUND Previous studies on the impact of sex differences after transcatheter aortic valve replacement (TAVR) have shown conflicting results. The aim was to analyze the risk of long-term mortality, heart failure hospitalization, myocardial infarction, stroke, bleeding and aortic valve reintervention in females versus males after TAVR. METHODS This nationwide, population-based cohort study included all patients who underwent TAVR in Sweden between 2008 and 2022 from the SWEDEHEART register. Additional baseline and outcome data were gathered from other national health data registers. Regression standardization was used to adjust for differences between the sexes. RESULTS Of 10,475 patients, 4,886 (47%) were female and 5,589 (53%) were male. The mean age was 81 years. The cumulative incidence of mortality at 1, 5, and 10 years was 8% vs. 10%, 38% vs. 45%, and 75% vs. 82% for females and males, respectively. After regression standardization, the risk of all-cause mortality was lower for females (absolute difference at 10 years of 6.4%, 95% confidence interval [CI] 4.4%-8.4%). The mean follow up was 3.1 years (maximum 14.1 years). Females also had a lower risk of major bleeding than males (absolute survival difference at 10 years of 4.0%, 95% CI 1.9%-6.2%), but there was no difference in the risk of heart failure, myocardial infarction, stroke, or reintervention between the sexes. CONCLUSIONS Females had a higher survival rate and a lower bleeding risk than males after TAVR. Sex-specific factors are important to consider in the management of patients after TAVR.
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Affiliation(s)
- Michael Dismorr
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Malin Granbom-Koski
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Emma Ellfors
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Cardiology, Stockholm South General Hospital, Stockholm, Sweden
| | - Andreas Rück
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Settergren
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ulrik Sartipy
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Natalie Glaser
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Cardiology, Stockholm South General Hospital, Stockholm, Sweden.
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Kumar M, Hu JR, Ali S, Khlidj Y, Upreti P, Ati L, Kumar S, Shaka H, Zheng S, Bae JY, Alraies MC, Mba B, Yadav N, Vora AN, Davila CD. Sex disparities in outcomes of transcatheter aortic valve implantation- a multi-year propensity-matched nationwide study. Int J Cardiol 2024; 418:132619. [PMID: 39370048 DOI: 10.1016/j.ijcard.2024.132619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Revised: 09/28/2024] [Accepted: 10/03/2024] [Indexed: 10/08/2024]
Abstract
Transcatheter Aortic Valve Implantation (TAVI) has revolutionized the management of severe aortic stenosis (AS), but the impact of sex on TAVI outcomes remains unclear. In this study, we examined differences between men and women in the post-procedural outcomes of TAVI, including healthcare burden and readmission rates. The Nationwide Readmissions Database (2016-2020) was utilized to identify hospitalizations for TAVI. A propensity score matching (PSM) model was used to match males and females. Outcomes were examined using Pearson's chi-squared test. Among 320,324 hospitalizations for TAVI, 142,054 (44.3 %) procedures were performed in women. After propensity matching (N = 165,894 with 82,947 hospitalizations in each group), women had higher in-hospital mortality (2.48 % vs 2.11 %, p: 0.001), stroke (2.14 % vs 1.49 %, p < 0.001), post-procedural bleeding (2.34 % vs 1.72 %, p < 0.001), vascular complications (1.2 % vs 0.7 %, p < 0.001), pericardial complications (1.13 % vs 0.60 %, p < 0.001), acute respiratory failure (ARF) (5.10 % vs 4.63 %, p < 0.001), need for transfusion (7 % vs 5.56 %, p < 0.001), need for vasopressors (2.48 % vs 2.11 %, p < 0.001) and major adverse cardiac and cerebrovascular events (MACCE) (7.53 % vs 6.85 %, p < 0.001). Meanwhile, women had modestly lower incidence of acute kidney injury (AKI) (10.17 % vs 11.88 %, p < 0.001), sudden cardiac arrest (SCA) (0.96 % vs 1.06 %, p: 0.042), cardiogenic shock (1.69 % vs 2.05 %, p < 0.001) and mechanical circulatory support (MCS) requirement (0.69 % vs 0.84 %, p < 0.001). With regard to readmissions, men had higher readmission rates at 30 days (16.07 % vs 14.75 %, p < 0.001) and 90 days (23.8 % vs 21.9 %, p < 0.001). No significant difference was observed in 180-day readmission rates between men and women after TAVI. Notably, procedure-related mortality decreased for both sexes from 2016 to 2020, accompanied by faster recovery times and reduced hospitalization costs (p-trend <0.001). In conclusion, women had higher mortality and post-procedural complication rates, while men had higher readmission rates, cardiogenic shock, AKI and need for mechanical circulatory support. While procedure-related mortality and resource utilization for TAVI have improved over time from 2016 to 2020, irrespective of sex, our findings highlight that significant disparities exist in TAVI outcomes.
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Affiliation(s)
- Manoj Kumar
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA.
| | - Jiun-Ruey Hu
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Shafaqat Ali
- Department of Internal Medicine, Louisiana State University, Shreveport, LA, USA
| | - Yehya Khlidj
- Department of Medicine, University of Algiers 1, Algiers, Algeria
| | - Prakash Upreti
- Sands Constellation Heart Institute, Rochester Regional Health, Rochester, NY, USA
| | - Lalit Ati
- Sparrow Hospital, Michigan State University, Lansing, MI, USA
| | - Sanjay Kumar
- Icahn School of Medicine at Mount Sinai, NYC Health + Hospitals, Queens, NY, USA
| | - Hafeez Shaka
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA
| | - Shengnan Zheng
- Division of Cardiology, Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA
| | - Ju Young Bae
- Division of Cardiology, Department of Medicine, Yale New Haven Health, Bridgeport Hospital, Bridgeport, CT, USA
| | - M Chadi Alraies
- Cardiovascular Institute, Detroit Medical Center, DMC Heart Hospital, 311 Mack Ave, Detroit, MI 48201, USA
| | - Benjamin Mba
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Neha Yadav
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA
| | - Amit N Vora
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Carlos D Davila
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA; Division of Cardiology, Department of Medicine, Yale New Haven Health, Bridgeport Hospital, Bridgeport, CT, USA
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Jin M, Zhang H, Zhou Q, Li S, Wang D. Transcatheter aortic valve implantation for severe aortic regurgitation using the J-Valve system: A midterm follow-up study. Catheter Cardiovasc Interv 2024. [PMID: 39248153 DOI: 10.1002/ccd.31196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 07/30/2024] [Accepted: 08/11/2024] [Indexed: 09/10/2024]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) is a well-established intervention for severe aortic valve stenosis. However, its application for severe aortic regurgitation (AR) is still under evaluation. This study aims to present the 3-year follow-up outcomes of the J-Valve system in managing severe AR. AIMS The aim of this study was to evaluate the mid-term efficacy and durability of the J-Valve system in the treatment of severe AR and to provide new information on this intervention. METHODS In this retrospective, single-center study, we evaluated the prognostic outcomes of patients with AR, who underwent treatment with the J-Valve system at Nanjing Drum Tower Hospital. Consecutive patients who were treated with the J-Valve were included in the analysis. The study focused on the echocardiographic follow-up to assess the effectiveness and durability of the J-Valve system in managing AR. RESULTS From January 2018 to December 2022, 36 high-risk AR patients treated with the J-Valve system had a procedural success rate of 97.2%, with one case requiring open-heart surgery due to valve displacement. Significant improvements were observed in left ventricular diameter (from 63.50 [58.75-69.50] mm to 56.50 [53.00-60.50] mm, p < 0.001) and left atrial diameter (from 44.00 [40.00-45.25] mm to 39.00 [36.75-41.00] mm, p = 0.003) postsurgery. All patients completed the 1-year follow-up, with an overall mortality rate of 2 out of 36 (5.6%). Among the surviving patients, there was one case of III° atrioventricular block and one case of stroke, both occurring within 90 days postsurgery. After a 3-year follow-up, 15.0% of patients had mild or moderate valvular regurgitation, with no cases of moderate or severe paravalvular leak. Additionally, 89.5% of patients were classified as New York Heart Association class I or II, showing significantly enhanced cardiac function. CONCLUSION The J-Valve system has shown positive therapeutic outcomes in treating AR, with notable effectiveness in managing the condition and significant improvements in heart failure symptoms and cardiac remodeling. However, due to the limited sample size and partial follow-up data, it is important to emphasize the need for further research with comprehensive long-term follow-up, to fully validate these results.
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Affiliation(s)
- Min Jin
- Department of Cardiac Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
| | - Haitao Zhang
- Department of Cardiac Surgery, Nanjing Drum Tower Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Graduate School of Peking Union Medical College, Nanjing, China
| | - Qing Zhou
- Department of Cardiac Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Shuchun Li
- Department of Cardiac Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Dongjin Wang
- Department of Cardiac Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
- Department of Cardiac Surgery, Nanjing Drum Tower Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Graduate School of Peking Union Medical College, Nanjing, China
- Department of Cardiac Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
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Krasniqi L, Brandes A, Mortensen PE, Gerke O, Riber L. Severe aortic stenosis treated with transcatheter aortic valve implantation or surgical aortic valve replacement with Perimount in Western Denmark 2016-2022: a nationwide retrospective study. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 39:ivae122. [PMID: 38944031 PMCID: PMC11229432 DOI: 10.1093/icvts/ivae122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 05/02/2024] [Accepted: 06/25/2024] [Indexed: 07/01/2024]
Abstract
OBJECTIVES The healthcare registries in Denmark present a unique opportunity to gain novel insights into the outcomes associated with both transcatheter and surgical approaches to aortic valve replacement. Our objective is to enhance shared decision-making by comparing long-term mortality and clinical outcomes between treatments. METHODS This observational study included all patients with severe aortic stenosis undergoing elective isolated transfemoral transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR) in Western Denmark between January 2016 and April 2022. Patient population and clinical data were identified from the Western Danish Heart Registry and the National Danish Patient Registry, respectively. A propensity score-matched population was generated. Outcomes were investigated according to Valve Academic Research Consortium-3. RESULTS A total of 2269 TAVI patients and 1094 SAVR patients where identified. The propensity score-matched population consisted of 468 TAVI patients (mean[SD]age, 75.0[5.3] years) and 468 SAVR patients (mean[SD] age, 75.1[4.6]years). The Kaplan-Meier estimate for the 5-year all-cause mortality was 29.8% in the TAVI group and 16.9% for in the SAVR group (P = 0.019). The risk of all stroke or transient ischaemic attack after five year was 15.1% in the TAVI group and 11.0% in the SAVR group (P = 0.047). CONCLUSIONS This study underscores the importance of evaluating all patient factors when choosing an aortic valve replacement method. Surgical aortic valve replacement was an excellent choice, especially for patients with New York Heart Association class I/II, ≥75 age, left ventricular ejection fraction ≥50%, or longer life expectancy.
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Affiliation(s)
- Lytfi Krasniqi
- Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Axel Brandes
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Cardiology, Esbjerg Hospital-University Hospital of Southern Denmark, Esbjerg, Denmark
| | - Poul Erik Mortensen
- Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
| | - Oke Gerke
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
| | - Lars Riber
- Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Gupta T, DeVries JT, Gilani F, Hassan A, Ross CS, Dauerman HL. Temporal Trends in Transcatheter Aortic Valve Replacement for Isolated Severe Aortic Stenosis. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2024; 3:101861. [PMID: 39132009 PMCID: PMC11308430 DOI: 10.1016/j.jscai.2024.101861] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/07/2024] [Accepted: 02/21/2024] [Indexed: 08/13/2024]
Affiliation(s)
- Tanush Gupta
- Division of Cardiology, University of Vermont Medical Center, Burlington, Vermont
| | - James T. DeVries
- Division of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Fahad Gilani
- Division of Cardiology, Catholic Medical Center, Manchester, New Hampshire
| | - Ansar Hassan
- Department of Cardiac Surgery, Maine Medical Center, Portland, Maine
| | - Cathy S. Ross
- Division of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Harold L. Dauerman
- Division of Cardiology, University of Vermont Medical Center, Burlington, Vermont
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Sharaf OM, Beaver TM. Aortic valve 2024: Which valve for which patient? J Thorac Cardiovasc Surg 2024:S0022-5223(24)00545-2. [PMID: 38950770 DOI: 10.1016/j.jtcvs.2024.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 04/17/2024] [Accepted: 06/19/2024] [Indexed: 07/03/2024]
Affiliation(s)
- Omar M Sharaf
- Division of Cardiovascular Surgery, Department of Surgery, University of Florida Health, Gainesville, Fla
| | - Thomas M Beaver
- Division of Cardiovascular Surgery, Department of Surgery, University of Florida Health, Gainesville, Fla.
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Movahed MR, Soltani Moghadam A, Hashemzadeh M, Hashemzadeh M. Gender-based Disparity in Performing Aortic Valve Surgery in the United State Before Availability of Percutaneous Valve Implantation. Crit Pathw Cardiol 2024; 23:103-105. [PMID: 38047892 DOI: 10.1097/hpc.0000000000000344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
BACKGROUND Aortic valve surgery has been performed increasingly in high-risk patients. The goal of this study was to evaluate this trend based on gender in the United States before the availability of percutaneous aortic valve replacement. METHOD The Nationwide Inpatient Sample database was utilized to calculate the age-adjusted utilization rate for aortic valve surgery from 1988 to 2011 in the United States using International Classification of Diseases, Ninth Revision coding for aortic valve surgery. RESULTS A total population of 258,506 patients who underwent aortic valve between 1988 and 2011 were available for our study over the age of 20. We found that the age-adjusted rate of aortic valve surgery gradually increased from 1988 until 2009 and stabilized thereafter with a persistently higher rate for men. For men, age-adjusted rate in 1988 was 13.3 per 100,000 versus 27.0 in year in the year 2011 per 100,000. For women, the age-adjusted rate in 1988 was 6.07 per 100,000 versus 11.4 in year 2011 per 100,000. CONCLUSIONS Aortic valve surgery utilization has stabilized in recent years in both genders in the United States. However, this rate has been persistently more than double in men. The cause of this higher utilization in males needs further investigation.
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Affiliation(s)
- Mohammad Reza Movahed
- From the Department of Medicine, University of Arizona College of Medicine, Phoenix, AZ
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Mahowald MK, Esmail K, Ezzeddine FM, Choi C, Mieszczanska H, Velarde G. Sex Disparities in Cardiovascular Disease. Methodist Debakey Cardiovasc J 2024; 20:107-119. [PMID: 38495656 PMCID: PMC10941692 DOI: 10.14797/mdcvj.1328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 01/30/2024] [Indexed: 03/19/2024] Open
Abstract
Cardiovascular disease is the leading cause of death in women. It remains underdiagnosed, undertreated, and portends worse outcomes in women than men. Disparities exist in every stage of science, from bench research to the editorial board of major journals and in every cardiovascular subspecialty. This review summarizes differences in cardiovascular risk factors and disparities in management and outcomes of ischemic heart disease, heart failure, aortic stenosis, and atrial fibrillation. It also provides an overview of female representation as participants and leaders of clinical trials, editorial boards, and academic institutions. Strategies to overcome these disparities are proposed with examples of successful programs.
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Affiliation(s)
| | - Khadeeja Esmail
- University of Florida College of Medicine, Jacksonville, Florida, US
| | | | - Calvin Choi
- University of Florida College of Medicine, Jacksonville, Florida, US
| | | | - Gladys Velarde
- University of Florida College of Medicine, Jacksonville, Florida, US
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Colombo A, Leone PP. Adoption of TAVR in Europe vs the United States: Is it Deja-Vù? J Am Coll Cardiol 2023; 82:1903-1905. [PMID: 37877905 DOI: 10.1016/j.jacc.2023.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/05/2023] [Accepted: 09/06/2023] [Indexed: 10/26/2023]
Affiliation(s)
- Antonio Colombo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; Cardio Center, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy.
| | - Pier Pasquale Leone
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; Cardio Center, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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