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Bansal S, Gupta A. TAVR outcomes in females - What is changing! Int J Cardiol 2024; 411:132247. [PMID: 38852857 DOI: 10.1016/j.ijcard.2024.132247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 06/05/2024] [Indexed: 06/11/2024]
Affiliation(s)
- Sandeep Bansal
- Department of Cardiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi 110029, India.
| | - Anunay Gupta
- Department of Cardiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi 110029, India
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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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Kim M, Kang DY, Ahn JM, Kim JB, Yeung AC, Nishi T, Fearon WF, Cantey EP, Flaherty JD, Davidson CJ, Malaisrie SC, Kim HJ, Lee J, Park J, Kim H, Cho S, Choi Y, Park SJ, Park DW. Sex-Specific Disparities in Clinical Outcomes After Transcatheter Aortic Valve Replacement Among Different Racial Populations. JACC. ASIA 2024; 4:292-302. [PMID: 38660112 PMCID: PMC11035955 DOI: 10.1016/j.jacasi.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 11/13/2023] [Accepted: 11/22/2023] [Indexed: 04/26/2024]
Abstract
Background Sex-related disparities in clinical outcomes following transcatheter aortic valve replacement (TAVR) and the impact of sex on clinical outcomes after TAVR among different racial groups are undetermined. Objectives This study assessed whether sex-specific differences in baseline clinical and anatomical characteristics affect clinical outcomes after TAVR and investigated the impact of sex on clinical outcomes among different racial groups. Methods The TP-TAVR (Trans-Pacific TAVR) registry is a multinational cohort study of patients with severe aortic stenosis who underwent TAVR at 2 major centers in the United States and 1 major center in South Korea. The primary outcome was a composite of death from any cause, stroke, or rehospitalization after 1 year. Results The incidence of the primary composite outcome was not significantly different between sexes (27.9% in men vs 28% in women; adjusted HR: 0.97; 95% CI: 0.79-1.20). This pattern was consistent in Asian (23.5% vs 23.3%; adjusted HR: 0.99; 95% CI: 0.69-1.41) and non-Asian (30.8% vs 31.6%; adjusted HR: 0.95; 95% CI: 0.72-1.24) cohorts, without a significant interaction between sex and racial group (P for interaction = 0.74). The adjusted risk for all-cause mortality was similar between sexes, regardless of racial group. However, the adjusted risk of stroke was significantly lower in male patients than in female patients, which was more prominent in the non-Asian cohort. Conclusions Despite significantly different baseline and procedural characteristics, there were no sex-specific differences in the adjusted 1-year rates of primary composite outcomes and all-cause mortality, regardless of different racial groups. (Transpacific TAVR registry [TP-TAVR]; NCT03826264).
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Affiliation(s)
- Mijin Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Do-Yoon Kang
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jung-Min Ahn
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Juyong Brian Kim
- Department of Medicine/Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Alan C. Yeung
- Department of Medicine/Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Takeshi Nishi
- Department of Medicine/Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - William F. Fearon
- Department of Medicine/Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Eric P. Cantey
- Bluhm Cardiovascular Institute Northwestern University Feinberg School of Medicine, Division of Cardiology and Cardiac Surgery, Departments of Medicine and Surgery, Chicago, Illinois, USA
| | - James D. Flaherty
- Bluhm Cardiovascular Institute Northwestern University Feinberg School of Medicine, Division of Cardiology and Cardiac Surgery, Departments of Medicine and Surgery, Chicago, Illinois, USA
| | - Charles J. Davidson
- Bluhm Cardiovascular Institute Northwestern University Feinberg School of Medicine, Division of Cardiology and Cardiac Surgery, Departments of Medicine and Surgery, Chicago, Illinois, USA
| | - S. Christopher Malaisrie
- Bluhm Cardiovascular Institute Northwestern University Feinberg School of Medicine, Division of Cardiology and Cardiac Surgery, Departments of Medicine and Surgery, Chicago, Illinois, USA
| | - Hwa Jung Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jinho Lee
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jinsun Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hoyun Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Suji Cho
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yeonwoo Choi
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seung-Jung Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Duk-Woo Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Yildirim A, Genc O, Pacaci E, Sen O, Kurt IH. Real-Life Performance and Clinical Outcomes of Portico Transcatheter Aortic Valve with FlexNav Delivery System: One-Year Data from a Single-Center Experience. J Clin Med 2023; 12:5373. [PMID: 37629415 PMCID: PMC10455755 DOI: 10.3390/jcm12165373] [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: 06/12/2023] [Revised: 08/11/2023] [Accepted: 08/13/2023] [Indexed: 08/27/2023] Open
Abstract
Significant progress has been made in both valves and delivery systems (DSs) for transcatheter aortic valve replacement (TAVR) procedures. We aimed to present one-year real-life data regarding TAVR procedures using Portico transcatheter heart valves (THVs) with new-generation, low-profile FlexNav DSs. This retrospective, single-center study enrolled 169 consecutive patients (mean age: 75.8 years, 68% females) with severe aortic stenosis undergoing TAVR with Portico THVs and FlexNav DSs between 2020 and 2021. We evaluated safety and efficacy outcomes, following the VARC-3 consensus, periprocedurally and at 30 days and 1 year. Procedural success was observed in 95.9% of cases, and no procedural mortality occurred. At 30 days, the rates of all-cause mortality, cardiovascular mortality, and neurological events were 4.7%, 3.6%, and 3.0%, respectively. Additionally, major vascular complications, acute kidney injury, and bleeding were recorded at rates of 11.2%, 14.8%, and 7.7%, respectively. The 1-year data showed all-cause mortality, cardiovascular mortality, and neurological event rates of 10.7%, 8.3%, and 7.7%, respectively. The moderate paravalvular leak and permanent pacemaker rates at 1 year were 2.6% and 12.2%, respectively. This real-life data provided evidence of positive outcomes and high technical success with Portico THVs and FlexNav DSs. Furthermore, we found low rates of mortality and neurological events, with satisfactory hemodynamic and functional results.
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Affiliation(s)
- Abdullah Yildirim
- Department of Cardiology, Adana City Training & Research Hospital, University of Health Sciences, 01230 Adana, Turkey; (E.P.); (O.S.); (I.H.K.)
| | - Omer Genc
- Department of Cardiology, Basaksehir Cam & Sakura City Hospital, 34480 Istanbul, Turkey;
| | - Emre Pacaci
- Department of Cardiology, Adana City Training & Research Hospital, University of Health Sciences, 01230 Adana, Turkey; (E.P.); (O.S.); (I.H.K.)
| | - Omer Sen
- Department of Cardiology, Adana City Training & Research Hospital, University of Health Sciences, 01230 Adana, Turkey; (E.P.); (O.S.); (I.H.K.)
| | - Ibrahim Halil Kurt
- Department of Cardiology, Adana City Training & Research Hospital, University of Health Sciences, 01230 Adana, Turkey; (E.P.); (O.S.); (I.H.K.)
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Burgess S, Cader FA, Shaw E, Banerjee S, Stehli J, Krishnamorthy R, Khor L, Forotan H, Bastiany A, Rao S, Chandrasekhar J, Zaman S, Alasnag M, Chieffo A, Coylewright M. Under-representation of Women as Proceduralists and Patients in TAVR and TMVr Procedures: Data, Implications and Proposed Solutions. Eur Cardiol 2022; 17:e27. [PMID: 36845217 PMCID: PMC9947929 DOI: 10.15420/ecr.2022.33] [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: 07/21/2022] [Accepted: 08/16/2022] [Indexed: 12/23/2022] Open
Abstract
Women are under-represented among transcatheter aortic valve replacement (TAVR) and transcatheter mitral valve repair (TMVr) operators. This review assesses the representation of women as patients and as proceduralists and trial authors in major structural interventions. Women are under-represented as proceduralists in structural interventions: only 2% of TAVR operators and 1% of TMVr operators are women. Only 1.5% of authors in landmark clinical TAVR and TMVr trials are interventional cardiologists who are women (4/260). Significant under-representation and under-enrolment of women in landmark TAVR trials is evident: the calculated participation-to-prevalence ratio (PPR) is 0.73, and in TMVr trials, the PPR is 0.69. Under-representation of women is also evident in registry data (PPR = 0.84 for TAVR registries and for TMVr registries). In structural interventional cardiology, women are under-represented as proceduralists, trial participants and patients. This under-representation has the potential to affect the recruitment of women to randomised trials, subsequent guideline recommendations, selection for treatment, patient outcomes and sex-specific data analysis.
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Affiliation(s)
- Sonya Burgess
- Department of Medicine, University of SydneySydney, New South Wales, Australia,Department of Cardiology, Nepean HospitalSydney, New South Wales, Australia
| | - F. Aaysha Cader
- Department of Cardiology, Ibrahim Cardiac Hospital & Research InstituteDhaka, Bangladesh,Department of Population Health, University of OxfordOxford, UK
| | - Elizabeth Shaw
- Department of Medicine, University of SydneySydney, New South Wales, Australia,Department of Cardiology, Hornsby Ku-ring-gai Hospital,Sydney, New South Wales, Australia,Department of Cardiology, Sydney Adventist Hospital, WahroongaSydney, New South Wales, Australia
| | - Shrilla Banerjee
- Department of Cardiology, Surrey and Sussex Healthcare NHS TrustRedhill, UK
| | - Julia Stehli
- Department of Cardiology, University Hospital ZurichZurich, Switzerland
| | | | - Lynn Khor
- Department of Cardiology, Nepean HospitalSydney, New South Wales, Australia
| | - Homa Forotan
- Department of Cardiology, Princess Alexandra HospitalBrisbane, Queensland, Australia
| | - Alexandra Bastiany
- Thunder Bay Regional Health Sciences Centre and Northern Ontario School of MedicineThunder Bay, Ontario, Canada
| | - Sarita Rao
- Department of Cardiology, Apollo HospitalIndore, India
| | - Jaya Chandrasekhar
- Department of Cardiology, Eastern HealthMelbourne, Victoria, Australia,Eastern Health Clinical School, Monash UniversityMelbourne, Victoria, Australia
| | - Sarah Zaman
- Westmead Applied Research Centre, University of SydneySydney, New South Wales, Australia,Department of Cardiology, Westmead HospitalSydney, New South Wales, Australia
| | - Mirvat Alasnag
- Department of Cardiology, King Fahd Armed Forces HospitalJeddah, Saudi Arabia
| | - Alaide Chieffo
- Interventional Cardiology Unit, San Raffaele Scientific InstituteMilan, Italy
| | - Megan Coylewright
- Section of Cardiovascular Medicine, Erlanger Heart and Lung InstituteChattanooga, Tennessee, US
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Zhu Y, Sasmita BR, Xue Y, Jiang Y, Huang B, Luo S. Sex differences on outcomes following left atrial appendage occlusion in atrial fibrillation: A systematic review and meta-analysis. Catheter Cardiovasc Interv 2022; 100:612-619. [PMID: 35801485 DOI: 10.1002/ccd.30323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 06/11/2022] [Accepted: 06/26/2022] [Indexed: 11/12/2022]
Abstract
There is a lack of sufficient data on sex-related differences in outcomes of nonvalvular atrial fibrillation (AF) patients following left atrial appendage occlusion (LAAO). We conducted a meta-analysis to investigate the procedural complications and long-term outcomes after LAAO in women versus men. We screened Medline, EMBASE, Cochrane Center Register of Controlled Trials, and Clinical Trials.gov. The inclusion criteria were studies targeting the sex-related differences in outcomes in nonvalvular AF patients treated by LAAO. Procedural endpoints of interest included success rate, pericardial complications, major bleeding, and vascular complications during hospitalization. Long-term outcomes included all-cause mortality and ischemic stroke during follow-up. Studies that merely considered sex in the subgroup analysis were not included. Six observational studies with a total of 64,035 patients were identified. The procedural success rates did not differ between sexes (odds ratio [OR]: 0.98, 95% confidence interval [CI]: 0.89-1.09, p = 0.77), while women experienced more pericardial complications (OR: 1.78, 95% CI: 1.58-2.01, p < 0.00001), major bleedings (OR: 2.04, 95% CI: 1.75-2.39, p < 0.00001), and vascular complications (OR: 1.75, 95% CI: 1.41-2.17, p < 0.00001) than men. The sensitivity analysis performed by removing the largest study showed good stability. The long-term mortality and stroke rates did not differ between women and men in either the 1-year subgroup or the 2-year subgroup. In conclusion, despite comparable procedural success rates, women have a significantly higher incidence of pericardial complications, major bleeding, and vascular complications following LAAO. The long-term mortality and stroke rates do not differ between the sexes.
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Affiliation(s)
- Yuansong Zhu
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bryan Richard Sasmita
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuzhou Xue
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yi Jiang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bi Huang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Suxin Luo
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Scarsini R, Venturi G, Pighi M, Lunardi M, Kotronias R, Del Sole PA, Rubino F, Tavella D, Pesarini G, Banning A, Ribichini F. Incomplete functional revascularization is associated with adverse clinical outcomes after transcatheter aortic valve implantation. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 42:47-52. [DOI: 10.1016/j.carrev.2022.02.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 02/24/2022] [Indexed: 01/09/2023]
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Tarantini G, Baumgartner H, Frank D, Husser O, Bleiziffer S, Rudolph T, Jeger R, Fraccaro C, Hovorka T, Wendler O. Four-year mortality in women and men after transfemoral transcatheter aortic valve implantation using the SAPIEN 3. Catheter Cardiovasc Interv 2021; 97:876-884. [PMID: 32886851 DOI: 10.1002/ccd.29257] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 06/07/2020] [Accepted: 08/02/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To investigate 4-year, post-transcatheter aortic valve implantation (TAVI) survival and predictors of survival by sex, in a real-world cohort that underwent transfemoral TAVI with SAPIEN 3 transcatheter heart valve. BACKGROUND Previous TAVI investigations of first-generation devices demonstrated an early- to mid-term survival advantage in women compared with men. METHODS SOURCE 3 (SAPIEN 3 Aortic Bioprosthesis European Outcome) is a post-approval, multicentre, observational registry. Patients (N = 1,694, 49.2% women, age 81.7 ± 6.7 years) with severe aortic stenosis and high surgical risk (logistic EuroSCORE 17.8%) underwent TAVI between 2014 and 2015. Kaplan-Meier event estimates were used to determine mortality by sex. Predictors of overall mortality were identified using a cox multivariate proportional hazard model. RESULTS At 4 years, women had lower all-cause mortality than men (36.0 vs 39.7%; p = .0911; HR: 0.87 [95% CI: 0.75-1.02]). No difference was observed for cardiac mortality between women 24.2% and men 24.7% (p = .76; HR: 0.97 [95% CI: 0.79-1.19]). When adjusted for baseline characteristics (age, height, weight, NYHA functional class, renal insufficiency, EuroScore, and tricuspid regurgitation), sex had no impact on mortality. CONCLUSIONS In this large, real-world cohort, all-cause mortality trended lower in women than men at 4 years post TAVI; however, several baseline factors, but not sex, were predictors of mortality. No difference between sexes was observed for cardiovascular mortality.
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Affiliation(s)
- Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Science, University of Padova, Padova, Italy
| | - Helmut Baumgartner
- Department of Cardiology III, University-Hospital Münster, Münster, Germany
| | - Derk Frank
- University Hospital Schleswig-Holstein, Kiel, Germany and DZHK (German Centre for Cardiovascular Research), Kiel, Germany
| | - Oliver Husser
- Department of Cardiology, Klinik für Innere Medizin, St.-Johannes-Hospital, Dortmund, Germany
| | - Sabine Bleiziffer
- Klinik für Thorax- und Kardiovaskularchirurgie, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Germany
| | - Tanja Rudolph
- Klinik für Thorax- und Kardiovaskularchirurgie, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Germany
| | - Raban Jeger
- University Hospital Basel, University of Basel, Basel, Switzerland
| | - Chiara Fraccaro
- Department of Cardiac, Thoracic and Vascular Science, University of Padova, Padova, Italy
| | - Tomas Hovorka
- Statistics Department, Edwards Lifesciences, Prague, Czech Republic
| | - Olaf Wendler
- Department of Cardiothoracic Surgery, King's College Hospital, London, UK
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Steeds RP, Messika-Zeitoun D, Thambyrajah J, Serra A, Schulz E, Maly J, Aiello M, Rudolph TK, Lloyd G, Bortone AS, Clerici A, Delle-Karth G, Rieber J, Indolfi C, Mancone M, Belle L, Lauten A, Arnold M, Bouma BJ, Lutz M, Deutsch C, Kurucova J, Thoenes M, Bramlage P, Frey N. IMPULSE: the impact of gender on the presentation and management of aortic stenosis across Europe. Open Heart 2021; 8:openhrt-2020-001443. [PMID: 33419934 PMCID: PMC7798778 DOI: 10.1136/openhrt-2020-001443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/09/2020] [Accepted: 12/01/2020] [Indexed: 11/10/2022] Open
Abstract
Aims There is an increasing awareness of gender-related differences in patients with severe aortic stenosis and their outcomes after surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI). Methods Data from the IMPULSE registry were analysed. Patients with severe aortic stenosis (AS) were enrolled between March 2015 and April 2017 and stratified by gender. A subgroup analysis was performed to assess the impact of age. Results Overall, 2171 patients were enrolled, and 48.0% were female. Women were characterised by a higher rate of renal impairment (31.7 vs 23.3%; p<0.001), were at higher surgical risk (EuroSCORE II: 4.5 vs 3.6%; p=0.001) and more often in a critical preoperative state (7.0vs 4.2%; p=0.003). Men had an increased rate of previous cardiac surgery (9.4 vs 4.7%; p<0.001) and a reduced left ventricular ejection fraction (4.9 vs 1.3%; p<0.001). Concomitant mitral and tricuspid valve disease was substantially more common among women. Symptoms were highly prevalent in both women and men (83.6 vs 77.3%; p<0.001). AVR was planned in 1379 cases. Women were more frequently scheduled to undergo TAVI (49.3 vs 41.0%; p<0.001) and less frequently for SAVR (20.3 vs 27.5%; p<0.001). Conclusions The present data show that female patients with severe AS have a distinct patient profile and are managed in a different way to males. Gender-based differences in the management of patients with severe AS need to be taken into account more systematically to improve outcomes, especially for women.
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Affiliation(s)
- Richard Paul Steeds
- Queen Elizabeth Hospital & Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | | | | | - Antonio Serra
- Interventional Cardiology Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Jiri Maly
- Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
- Department of Cardiovascular Surgery, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Marco Aiello
- Department of Cardiothoracic Surgery, Foundation IRCCS Policlinico S.Matteo, Pavia, Italy
| | - Tanja K Rudolph
- Department of Cardiology, Heart and Diabetes Center Bad Oeynhausen, Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | - Guy Lloyd
- St Bartholomew's Hospital, London, UK
| | | | | | | | - Johannes Rieber
- Herzkatheterlabor Nymphenburg and Department of Cardiology, University of Munich, Munich, Germany
| | - Ciro Indolfi
- Division of Cardiology and URT CNR of IFC, University Magna Graecia, Catanzaro, Italy
| | | | - Loic Belle
- Centre Hospital d'Annecy, Annecy, France
| | - Alexander Lauten
- Department for Cardiology, Helios Erfurt Clinic, Erfurt, Germany
| | - Martin Arnold
- Department of Cardiology, University of Erlangen, Erlangen, Germany
| | | | - Matthias Lutz
- Department of Cardiology and Angiology, University of Kiel, Kiel, Germany
| | - Cornelia Deutsch
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | | | | | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Norbert Frey
- Department of Cardiology and Angiology, University of Kiel, Kiel, Germany
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O’Kelly AC, Honigberg MC. Sex Differences in Cardiovascular Disease and Unique Pregnancy-Associated Risk Factors in Women. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020. [DOI: 10.1007/s11936-020-00860-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Rationale and design of a prospective, randomized, controlled, multicenter study to evaluate the safety and efficacy of transcatheter heart valve replacement in female patients with severe symptomatic aortic stenosis requiring aortic valve intervention (Randomized researcH in womEn all comers wIth Aortic stenosis [RHEIA] trial). Am Heart J 2020; 228:27-35. [PMID: 32745733 DOI: 10.1016/j.ahj.2020.06.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 06/24/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Limited data suggest that transcatheter (TAVR) as compared with surgical aortic valve replacement (SAVR) may be more effective in female than male patients. To date, most evidence is derived from subgroup analyses of large trials, and a dedicated randomized trial evaluating whether there is a difference in outcomes between these interventions in women is warranted. The RHEIA trial will compare the safety and efficacy of TAVR with SAVR in women with severe symptomatic aortic stenosis requiring aortic valve intervention, irrespective of surgical risk. METHODS/DESIGN The RHEIA trial is a prospective, randomized, controlled study that will enroll up to 440 patients across 35 sites in Europe. Women with severe symptomatic aortic stenosis, with any but prohibitive surgical risk status, will be randomized 1:1 to undergo aortic valve intervention with either transfemoral TAVR with the SAPIEN 3 or SAPIEN 3 Ultra device or SAVR and followed up for 1 year. The objective is to determine whether TAVR is non-inferior to SAVR in this patient population and, if this is fulfilled whether TAVR is actually superior to SAVR. The primary safety/efficacy endpoint is a composite of all-cause mortality, all stroke, and re-hospitalization (for valve or procedure-related symptoms or worsening congestive heart failure) at 1 year post-procedure. Other outcomes (assessed at 30 days and/or 1 year) include all-cause mortality; bleeding, vascular, cardiac, cerebrovascular and renal complications; aortic valve prosthesis and left ventricular function; cognitive function, health status, and quality of life. DISCUSSION The RHEIA study has been designed to evaluate the safety and efficacy of TAVR compared with SAVR specifically in women with severe symptomatic aortic stenosis, irrespective of the level of surgical risk. The results will be the first to provide specific randomized evidence to guide treatment selection in female patients with severe symptomatic aortic stenosis. TRIAL REGISTRATION clinicaltrials.gov: NCT04160130.
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Sex Differences in In-Hospital Outcomes of Transcatheter Aortic Valve Replacement. Curr Probl Cardiol 2020; 46:100694. [PMID: 33039143 DOI: 10.1016/j.cpcardiol.2020.100694] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 08/15/2020] [Indexed: 01/09/2023]
Abstract
Since the introduction of transcatheter aortic valve replacement (TAVR), there has been a paradigm shift in the management of severe aortic stenosis. While women represent almost half of the patients undergoing TAVR, there are limited data on sex-based comparisons in hospital outcomes and predictors of mortality in women and men. The National Inpatient Sample database from 2012 to 2015 was used to identify TAVR using international classification of diseases-9 clinical modification procedure codes 35.05 and 35.06. We identified 61,239 patients who underwent TAVR between 2012 and 2015. After adjusting for potential confounders, women had higher odds of all-cause mortality as compared to men [odds ratio (OR) 1.25, 95% confidence interval (CI): 1.01-1.54; P = 0.036]. Moreover, women had significantly increased odds of cardiac complications [OR 2.41, 95% CI: 1.67-3.49; P ≤ 0.01], respiratory complications [OR 1.20 95% CI: 1.07-1.34; P = 0.001], major hemorrhage requiring transfusion [OR 1.51, 95% CI: 1.37-1.67; P ≤ 0.001], neurological complications [OR 1.38, 95% CI: 0.95-1.99; P = 0.08], need for vasopressor treatment [OR 1.33, 95% CI: 1.01-1.75; P = 0.04], and vascular complications [OR 1.73, 95% CI: 1.19-2.52; P = 0.004]. On the contrary, the odds of pacemaker requirement [OR 0.85, 95% CI: 0.75-0.97; P = 0.02], and acute kidney injury [OR 0.80, 95% CI: 0.71-0.91; P = 0.001] were significantly lower in women. Among patients undergoing TAVR, women were more likely to have in-hospital complications and mortality as compared with men. Further studies are needed to identify the discrepancy in in-hospital outcomes with sex-specific factors being considered.
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13
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Kim K, Furukawa Y. Sex-related differences in the response to exercise testing in asymptomatic aortic stenosis. Int J Cardiol 2020; 304:128-129. [DOI: 10.1016/j.ijcard.2020.01.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 01/20/2020] [Indexed: 11/25/2022]
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14
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Côté N, Clavel MA. Sex Differences in the Pathophysiology, Diagnosis, and Management of Aortic Stenosis. Cardiol Clin 2020; 38:129-138. [DOI: 10.1016/j.ccl.2019.09.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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15
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Goel H, Kumar A, Garg N, Mills JD. Men are from mars, women are from venus: Factors responsible for gender differences in outcomes after surgical and trans-catheter aortic valve replacement. Trends Cardiovasc Med 2019; 31:34-46. [PMID: 31902553 DOI: 10.1016/j.tcm.2019.11.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 11/21/2019] [Accepted: 11/23/2019] [Indexed: 01/09/2023]
Abstract
Females suffer higher operative (30-day) mortality than males after surgical aortic valve replacement (SAVR). In contrast, outcomes after trans-catheter aortic valve replacement (TAVR) seem to favor females, both in terms of procedural mortality, and more prominently, medium to long-term survival. With an ever-greater number of TAVR procedures being performed, an understanding of factors responsible for gender differences in outcomes after the two AVR modalities is critical for better patient selection. Current evidence suggests that this gender difference in outcomes after SAVR and TAVR stems from differences in baseline risk profiles, as well as inherent anatomic/physiological differences between genders. This review attempts to examine these clinical and physiological factors, with a goal of guiding better patient selection for each AVR modality, and to highlight areas that beg further investigation.
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Affiliation(s)
- Harsh Goel
- Department of Medicine, St. Luke's University Hospital, Bethlehem, PA, United States; Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States.
| | - Ashish Kumar
- Department of Medicine, Wellspan York Hospital, York, PA, United States
| | - Nadish Garg
- Department of Medicine, St Barnabas Medical Center, Livingston, NJ, United States
| | - James D Mills
- Department of Medicine, Division of Cardiovascular Medicine, West Virginia University Heart and Vascular Institute, Morgantown, WV, United States
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16
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Laricchia A, Bellini B, Romano V, Khawaja S, Montorfano M, Chieffo A. Sex and Transcatheter Aortic Valve Implantation: Impact of Female Sex on Clinical Outcomes. Interv Cardiol 2019; 14:137-141. [PMID: 31867058 PMCID: PMC6918465 DOI: 10.15420/icr.2019.07.r1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 06/24/2019] [Indexed: 01/09/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) has emerged as an alternative treatment for severe symptomatic aortic stenosis in patients who are not suitable for surgery or are at high surgical risk. Approximately 50% of patients undergoing TAVI are female and this is reflected by a higher inclusion rate of women in TAVI trials. However, women undergoing TAVI have different baseline clinical characteristics in comparison to men, with fewer comorbidities and a more preserved left ventricular ejection fraction. This translates into favourable outcomes after TAVI, despite a higher rate of peri-procedural complications. This article discusses gender differences in terms of presentation, procedural characteristics and post-procedural results in patients with aortic stenosis undergoing TAVI, with particular focus on possible sex-specific factors affecting outcome.
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Affiliation(s)
- Alessandra Laricchia
- Interventional Cardiology Unit, GVM Care and Research, Maria Cecilia HospitalCotignola, Italy
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific InstituteMilan, Italy
| | - Barbara Bellini
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific InstituteMilan, Italy
| | - Vittorio Romano
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific InstituteMilan, Italy
| | - Saud Khawaja
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific InstituteMilan, Italy
| | - Matteo Montorfano
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific InstituteMilan, Italy
| | - Alaide Chieffo
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific InstituteMilan, Italy
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17
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Ueshima D, Masiero G, Schiavo A, Badawy MRA, Fraccaro C, Napodano M, Brener SJ, Tarantini G. Time course of the survival advantage of transcatheter over surgical aortic valve replacement: Interplay between sex and patient risk profile. Catheter Cardiovasc Interv 2019; 94:746-752. [PMID: 30821116 DOI: 10.1002/ccd.28124] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 12/12/2018] [Accepted: 01/20/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The aim of this study was to explore the time course of survival advantage of TAVR over SAVR as function of the patients' risk and sex. BACKGROUND Women have been reported to have better survival than men undergoing transcatheter aortic valve replacement (TAVR). However, scant data on the sex-based survival benefit of TAVR over surgical aortic valve replacement (SAVR) are available. METHODS A systematic review of studies reporting clinical outcomes of men and women undergoing TAVR or SAVR was performed. Studies were divided into two groups according to average patient's risk score and the interplay of surgical risk and sex on outcomes were analyzed. RESULTS Eight studies involving 6,596 women and 7,204 men patients were extracted. Unlike mens, women patients had survival advantage from TAVR over SAVR that became substantial at 1 year from index procedure and persisted at 2-year of follow-up. Moreover, this sex-based TAVR survival advantage was mainly observed in higher surgical risk patients. Men showed a significantly lower rate of residual paravalvular leak after SAVR. CONCLUSIONS Women patients had a selective mortality benefit from TAVR compared to SAVR. This sex-based TAVR benefit was mainly observed in high surgical risk patients beyond 1 year from procedure.
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Affiliation(s)
- Daisuke Ueshima
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Giulia Masiero
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Alessandro Schiavo
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Mostafa Rabea Abdelhaleem Badawy
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy.,Department of Cardiology, Faculty of Medicine, Minia University, Minya, Egypt
| | - Chiara Fraccaro
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Massimo Napodano
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Sorin J Brener
- Department of Medicine, Cardiac Catheterization Laboratory, New York Methodist Hospital, New York, New York
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
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18
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Kilic A, Bianco V, Gleason TG, Lee JS, Schindler J, Navid F, Kliner D, Cavalcante JL, Mulukutla SR, Sultan I. Longitudinal Outcomes of Women Undergoing Transcatheter Aortic Valve Replacement. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2019; 14:311-320. [PMID: 31088318 DOI: 10.1177/1556984519842943] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Recent data have suggested that women have a survival benefit at 1-year follow-up. However, long-term gender-based TAVR outcomes are lacking. METHODS All patients undergoing isolated TAVR from 2011 to 2017 were included. Patients were stratified by gender. The primary outcomes of the study were 3-year mortality and 3-year hospital readmissions. Multivariable logistic regression analysis was used to evaluate the risk-adjusted impact of gender on TAVR outcomes. RESULTS A total of 1,036 patients were divided into male (n = 518) and female (n = 518) cohorts. Women had a borderline significantly increased STS PROM (8.3% ± 5 vs. 7.7% ± 4.4; P = 0.05). The majority of procedures were performed under conscious sedation (male: 89% vs. female: 88%; P = 0.62) and via transfemoral access (male: 81.8% vs. female: 81.4%; P = 0.46). There was no difference in operative (30-day) mortality (male: 15 [3.3%] vs. female: 17 [3.7%]; P = 0.77) or 30-day readmissions (male: 40 [10.8%] vs. female: 44 [12.2%]; P = 0.56). Perioperative blood product usage was higher for women (male: 8.1% vs. female: 14.1%; P = 0.002). There was no significant difference in major vascular complications (male: 0.4% vs. female: 1.0%; P = 0.26) or major bleeding (male: 0.2% vs. female: 0.4%; P = 0.56). Permanent pacemaker placement was higher for males (11.6% vs. 7.0%; P = 0.01). On risk-adjusted multivariable analysis, gender was not a factor associated with mortality (HR 0.99 [0.76 to 1.30]; P = 0.99) or readmission (HR 0.90 [0.72 to 1.14]; P = 0.42) at 5 years. CONCLUSIONS There was no difference in survival or readmissions on multivariable analysis for women undergoing TAVR at 3 years. Longitudinal multi-institutional data will be important to validate these findings.
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Affiliation(s)
- Arman Kilic
- 1 Department of Cardiothoracic Surgery, Division of Cardiac Surgery, University of Pittsburgh, PA, USA
- 2 Heart and Vascular Institute, University of Pittsburgh Medical Center, PA, USA
| | - Valentino Bianco
- 1 Department of Cardiothoracic Surgery, Division of Cardiac Surgery, University of Pittsburgh, PA, USA
| | - Thomas G Gleason
- 1 Department of Cardiothoracic Surgery, Division of Cardiac Surgery, University of Pittsburgh, PA, USA
- 2 Heart and Vascular Institute, University of Pittsburgh Medical Center, PA, USA
| | - Joon S Lee
- 2 Heart and Vascular Institute, University of Pittsburgh Medical Center, PA, USA
| | - John Schindler
- 2 Heart and Vascular Institute, University of Pittsburgh Medical Center, PA, USA
| | - Forozan Navid
- 1 Department of Cardiothoracic Surgery, Division of Cardiac Surgery, University of Pittsburgh, PA, USA
- 2 Heart and Vascular Institute, University of Pittsburgh Medical Center, PA, USA
| | - Dustin Kliner
- 2 Heart and Vascular Institute, University of Pittsburgh Medical Center, PA, USA
| | - Joao L Cavalcante
- 2 Heart and Vascular Institute, University of Pittsburgh Medical Center, PA, USA
| | - Suresh R Mulukutla
- 2 Heart and Vascular Institute, University of Pittsburgh Medical Center, PA, USA
| | - Ibrahim Sultan
- 1 Department of Cardiothoracic Surgery, Division of Cardiac Surgery, University of Pittsburgh, PA, USA
- 2 Heart and Vascular Institute, University of Pittsburgh Medical Center, PA, USA
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19
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Itzhaki Ben Zadok O, Kornowski R, Finkelstein A, Barbash I, Danenberg H, Segev A, Guetta V, Halkin A, Vaknin H, Planer D, Assali A, Barsheshet A, Orvin K. Temporal Trends in Gender-Related Differences and Outcomes in Patients Who Underwent Transcatheter Aortic Valve Implantation (from the Israeli Transcatheter Aortic Valve Implantation Multicenter Registry). Am J Cardiol 2019; 123:108-115. [PMID: 30539744 DOI: 10.1016/j.amjcard.2018.09.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 09/05/2018] [Accepted: 09/11/2018] [Indexed: 12/20/2022]
Abstract
We evaluated temporal trends in gender-related differences in patients who underwent transcatheter aortic valve implantation (TAVI) for severe symptomatic aortic stenosis from a multicenter TAVI registry during the years 2008 to 2016. Our final cohort included 1,159 males and 1,370 females, with a median follow-up of 2.3 (IQR 1.2, 4.4) years. For temporal trends analysis, the entire population was divided according to period of procedure: 2008 to 2012 and 2013 to 2016. During the 2008 to 2012 period, the rates of in-hospital aortic paravalvular leak, myocardial infarction, pacemaker implantation, and stroke were higher among men than women, but became comparable between the gender during the 2013 to 2016 period. Multivariate analysis demonstrated that female patients who underwent TAVI between the years 2008 and 2012 had a 26% lower risk of death compared with male patients (p = 0.004), but there were no gender-related differences in mortality risk between the years 2013 and 2016 (hazard ratio 1.07, p = 0.6; gender-by-year of procedure, p = 0.027 for interaction). In conclusion, the favorable long-term prognosis described in female patients during the earlier TAVI period seemed to diminish with contemporary TAVI. This might be attributed to current technological advances and improved valve sizing, with a more significant benefit in favor of male patients.
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Affiliation(s)
- Osnat Itzhaki Ben Zadok
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ariel Finkelstein
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Cardiology, Sourasky Medical Center, Tel Aviv, Israel
| | - Israel Barbash
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Leviev Heart Center, Chaim Sheba Medical Center, Tel HaShomer Hospital, Ramat Gan, Israel
| | - Haim Danenberg
- Department of Cardiology, Hadassah Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Amit Segev
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Leviev Heart Center, Chaim Sheba Medical Center, Tel HaShomer Hospital, Ramat Gan, Israel
| | - Victor Guetta
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Leviev Heart Center, Chaim Sheba Medical Center, Tel HaShomer Hospital, Ramat Gan, Israel
| | - Amir Halkin
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Cardiology, Sourasky Medical Center, Tel Aviv, Israel
| | - Hana Vaknin
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Planer
- Department of Cardiology, Hadassah Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Abid Assali
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alon Barsheshet
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Katia Orvin
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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20
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Benamer H, Auffret V, Cayla G, Chevalier B, Dupouy P, Eltchaninoff H, Gilard M, Guerin P, Iung B, Koning R, Monsegu J, Lantelme P, Le Breton H, Lefèvre T, Verhoye JP, Commeau P, Motreff P. Position paper of French Interventional Group (GACI) for TAVI in France in 2018. Ann Cardiol Angeiol (Paris) 2018; 67:455-465. [PMID: 30376969 DOI: 10.1016/j.ancard.2018.09.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Aortic stenosis is a frequent disease in the elderly. Its prevalence is 0.4% with a sharp increase after the age of 65, and its outcome is very poor when the patient becomes symptomatic. The interventional procedure known as TAVI (trans-catheter aortic valve implantation), which was developed in France and carried out for the first time in Rouen by Prof. Alain Cribier and his team in 2002, has proven to be a valid alternative to surgical aortic valve replacement. At first, this technique was shown to be efficient in patients with contra-indications to surgical treatment or deemed to be at high surgical risk. Given the very promising outcomes achieved as a result of close heart team collaboration, appropriate patient selection, simplified procedures and reduced complication rates, transfemoral (TF) TAVI is now preferred in symptomatic intermediate risk patients>75 years old according to the latest ESC guidelines. In 2017, in France, TAVI is currently performed in 50 centers with on-site cardiac surgery. The 2016 TAVI outcomes recorded in the French national TAVI registry (France TAVI) are very encouraging and show that for 7133 patients treated (age 83.4±7 years, logistic Euroscore 14%), 87% of whom via the TF approach, cross-over to surgery was very low (0.5%) with a 3.0% in-hospital mortality rate. The substantial increase in TAVI indications and the improvement of its outcomes may in the near future call for a reconsideration of the number of high volume centers authorized to carry out this technique.
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Affiliation(s)
- H Benamer
- ICPS Jacques Cartier, Ramsay générale de santé, 6, avenue du Noyer Lambert, 91300 Massy, France.
| | - V Auffret
- Inserm U1099, service de cardiologie et maladies vasculaires, CIC-IT 804, laboratoire de traitement du signal et de l'image, université de Rennes 1, CHU Pontchaillou, 35000 Rennes, France
| | - G Cayla
- Service de cardiologie, université de Montpellier, CHU Nîmes, 34000 Nîmes, France
| | - B Chevalier
- ICPS Jacques Cartier, Ramsay générale de santé, 6, avenue du Noyer Lambert, 91300 Massy, France
| | - P Dupouy
- Hôpital privé d'Anthony, 25, rue De La Providence, 92160 Antony, France
| | - H Eltchaninoff
- Inserm U1096, department of cardiology, FHU REMOD-VHF, Rouen university hospital, Normandie Univ, Unirouen, 76000 Rouen, France
| | - M Gilard
- CHU La Cavale Blanche, boulevard Tanguy Prigent, 29609 Brest, France
| | - P Guerin
- CHU hôpital G R Laennec, boulevard Jacques Monod, 44800 St Herblain, France
| | - B Iung
- Hôpital Bichat-Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France
| | - R Koning
- Clinique Saint Hilaire, 2, place Saint Hilaire, 76000 Rouen, France
| | - J Monsegu
- Groupe hospitalier mutualiste de Grenoble, 8, rue du Dr Calmette, 38000 Grenoble cedex 1, France
| | - P Lantelme
- Hôpital Croix Rousse, 103, Gr De La Croix Rousse à Lyon, 34000 Lyon, France
| | - H Le Breton
- Inserm U1099, service de cardiologie et maladies vasculaires, CIC-IT 804, laboratoire de traitement du signal et de l'image, université de Rennes 1, CHU Pontchaillou, 35000 Rennes, France
| | - T Lefèvre
- ICPS Jacques Cartier, Ramsay générale de santé, 6, avenue du Noyer Lambert, 91300 Massy, France
| | - J-P Verhoye
- Service de chirurgie cardiaque, université de Rennes, CHU Pontchaillou, 35000 Rennes, France
| | - P Commeau
- Polyclinique Les Fleurs Quartier Quiez, 83190 Ollioules, France
| | - P Motreff
- Department of cardiology, Gabriel Montpied hospital, Clermont-Ferrand university hospital, 58, rue Montalembert, 63003 Clermont-Ferrand cedex 1, France
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21
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Abstract
Transcatheter aortic valve replacement (TAVR) is a safe and effective therapy for aortic valve replacement in patients ineligible for or at high risk for surgery. However, outcomes after TAVR based on an individual's sex remain to be fully elucidated. We searched PUBMED and EMBASE using the keywords: "transcatheter aortic valve replacement," "transcatheter aortic valve implantation," "sex differences," "gender," "sex characteristics" and collected information on baseline features, procedural characteristics, and postprocedural outcomes in women. Inclusion/exclusion resulted in 23 publications. Women had less preexisting comorbidities than men. Most studies reported better survival in women (range of hazard ratio [95% CI] = 0.27 [0.09-0.84] to 0.91 [0.75-1.10]). At 30 days, women also had more vascular complications (6-20% vs 2-14%) and higher bleeding rates (10-44% vs 8-25%). Stroke rates were similar at 30 days (women, 1-7%; men, 1-5%). This literature review showed better survival in women than men after TAVR. However, women had more vascular complications and bleeding; stroke rates were similar. These findings may partly be explained by fewer baseline comorbidities in women. These results should be interpreted with caution as most measures only include unadjusted percentages.
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22
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Panoulas VF, Francis DP, Ruparelia N, Malik IS, Chukwuemeka A, Sen S, Anderson J, Nihoyannopoulos P, Sutaria N, Hannan EL, Samadashvili Z, D'Errigo P, Schymik G, Mehran R, Chieffo A, Latib A, Presbitero P, Mehilli J, Petronio AS, Morice MC, Tamburino C, Thyregod HGH, Leon M, Colombo A, Mikhail GW. Female-specific survival advantage from transcatheter aortic valve implantation over surgical aortic valve replacement: Meta-analysis of the gender subgroups of randomised controlled trials including 3758 patients. Int J Cardiol 2018; 250:66-72. [PMID: 29169764 DOI: 10.1016/j.ijcard.2017.05.047] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 03/05/2017] [Accepted: 05/09/2017] [Indexed: 01/09/2023]
Abstract
Transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS) is the first area of interventional cardiology where women are treated as often as men. In this analysis of the gender specific results of randomised controlled trials (RCTs) comparing TAVI with surgical aortic valve replacement (SAVR) we aimed to determine whether gender affects the survival comparison between TAVI and SAVR. We identified all RCTs comparing TAVI versus SAVR for severe AS and reporting 1 and/or 2year survival. Summary odds ratios (ORs) were obtained using a random-effects model. Heterogeneity was assessed using the Q statistic and I2. Four RCTs met the criteria, totalling 3758 patients, 1706 women and 2052 men. Amongst females, TAVI recipients had a significantly lower mortality than SAVR recipients, at 1year (OR 0.68; 95%CI 0.50 to 0.94) and at 2years (OR 0.74; 95%CI 0.58 to 0.95). Amongst males there was no difference in mortality between TAVI and SAVR, at 1year (OR 1.09; 95%CI 0.86 to 1.39) or 2years (OR 1.05; 95%CI 0.85 to 1.3). The difference in treatment effect between genders was significant at both 1year (pinteraction=0.02) and 2years (pinteraction=0.04). In women TAVI has a 26 to 31% lower mortality odds than SAVR. In men, there is no difference in mortality between TAVI and SAVR.
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Affiliation(s)
- Vasileios F Panoulas
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK; Cardiology Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK.
| | - Darrel P Francis
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK
| | - Neil Ruparelia
- Cardiology Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Iqbal S Malik
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK; Cardiology Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Andrew Chukwuemeka
- Cardiothoracic Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust
| | - Sayan Sen
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK; Cardiology Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Jonathan Anderson
- Cardiothoracic Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust
| | - Petros Nihoyannopoulos
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK; Cardiology Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Nilesh Sutaria
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK
| | - Edward L Hannan
- School of Public Health, University at Albany, State University of New York, Albany, NY, USA
| | - Zaza Samadashvili
- School of Public Health, University at Albany, State University of New York, Albany, NY, USA
| | - Paola D'Errigo
- National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy
| | - Gerhard Schymik
- Medical Clinic IV, Department of Cardiology, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Freiburg, Germany
| | - Roxana Mehran
- Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Alaide Chieffo
- Cardiology department, San Raffaele Scientific Institute, Milan, Italy
| | - Azeem Latib
- Cardiology department, San Raffaele Scientific Institute, Milan, Italy
| | - Patrizia Presbitero
- Hemodynamic and Invasive Cardiology Unit, IRCCS Istituto Clinico Humanitas, Milan, Italy
| | - Julinda Mehilli
- Munich University Clinic, Ludwig-Maximilians University, Munich, Germany,; Munich Heart Alliance at Deutsches Zentrum für Herz-Kreislauf-Forschung, Munich, Germany
| | | | - Marie-Claude Morice
- RAMSAY, Génerale de Santé,ICPS, Institut Cardiovasculaire Paris Sud, Massy, France
| | - Corrado Tamburino
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Italy; ETNA Foundation, Catania, Italy
| | - Hans G H Thyregod
- Department of Cardiothoracic Surgery, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Martin Leon
- Columbia University Medical Center, New York, USA
| | - Antonio Colombo
- Cardiology department, San Raffaele Scientific Institute, Milan, Italy
| | - Ghada W Mikhail
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK; Cardiology Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
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23
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Zusterzeel R, Mishra NK, Beydoun H, Laschinger J, Wu C, Dong LM, Lin JA, Marinac-Dabic D, Strauss DG, Caños DA. Sex-Specific Outcomes After Transcatheter Aortic Valve Replacement: FDA Patient-Level Meta-Analysis of Premarket Clinical Trials. J Womens Health (Larchmt) 2018; 27:808-814. [DOI: 10.1089/jwh.2017.6760] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | - Hind Beydoun
- U.S. Food and Drug Administration, Silver Spring, Maryland
| | | | - Changfu Wu
- U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Li Ming Dong
- U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Ja-An Lin
- U.S. Food and Drug Administration, Silver Spring, Maryland
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24
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Itchhaporia D. Transcatheter aortic valve replacement in women. Clin Cardiol 2018; 41:228-231. [PMID: 29485678 DOI: 10.1002/clc.22912] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 01/23/2018] [Accepted: 01/30/2018] [Indexed: 11/07/2022] Open
Abstract
This review examines the treatment options for women with severe aortic stenosis. It is known that female sex is associated with poorer outcomes after surgical aortic valve replacement. With the introduction and adoption of transcatheter aortic valve replacement as an alternative to surgical aortic valve replacement, there are emerging data about the potential impact of female sex-specific characteristics on clinical outcomes after transcatheter aortic valve replacement. These data provide an insight into female-specific aspects of the treatment of aortic stenosis. The data can help guide patient selection, choice of intervention method, and evaluation of risk to help improve long-term follow-up of patients with aortic stenosis.
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Affiliation(s)
- Dipti Itchhaporia
- Robert and Georgia Roth Endowed Chair for Excellence in Cardiac Care, Director of Disease Management, Jeffrey M. Carlton Heart and Vascular Institute, Hoag Memorial Hospital Presbyterian, California
- Assistant Clinical Professor, School of Medicine, University of California, Irvine
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25
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Hervault M, Clavel MA. Sex-related Differences in Calcific Aortic Valve Stenosis: Pathophysiology, Epidemiology, Etiology, Diagnosis, Presentation, and Outcomes. STRUCTURAL HEART-THE JOURNAL OF THE HEART TEAM 2018. [DOI: 10.1080/24748706.2017.1420273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Maxime Hervault
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Canada
| | - Marie-Annick Clavel
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Canada
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26
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Ando T, Akintoye E, Telila T, Briasoulis A, Takagi H, Schreiber T, Afonso L, Grines CL. Hospital outcomes of transcatheter versus surgical aortic valve replacement in female in the United States. Catheter Cardiovasc Interv 2017; 91:813-819. [DOI: 10.1002/ccd.27362] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 09/02/2017] [Accepted: 09/09/2017] [Indexed: 12/21/2022]
Affiliation(s)
- Tomo Ando
- Wayne State University, Harper hospital/Detroit Medical Center, Division of Cardiology; Detroit Michigan
| | - Emmanuel Akintoye
- Wayne State University, Harper hospital/Detroit Medical Center, Division of Cardiology; Detroit Michigan
| | - Tesfaye Telila
- Wayne State University, Harper hospital/Detroit Medical Center, Division of Cardiology; Detroit Michigan
| | | | - Hisato Takagi
- Shizuoka Medical Center, Division of Cardiovascular Surgery; Shizuoka Japan
| | - Theodore Schreiber
- Wayne State University, Harper hospital/Detroit Medical Center, Division of Cardiology; Detroit Michigan
| | - Luis Afonso
- Wayne State University, Harper hospital; Michigan
| | - Cindy L. Grines
- North Shore University Hospital, Northwell Health System, Department of Internal Medicine, Division of Cardiology, Manhasset; New York, United States
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27
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Sex-related differences in clinical outcomes and quality of life after transcatheter aortic valve implantation for severe aortic stenosis. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2017; 13:233-239. [PMID: 29056996 PMCID: PMC5644042 DOI: 10.5114/aic.2017.70195] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Accepted: 05/18/2017] [Indexed: 11/30/2022] Open
Abstract
Introduction There are inconsistent data on the sex-related differences in clinical outcomes and quality of life (QoL) after transcatheter aortic valve implantation (TAVI). Aim We sought to investigate sex-related differences in procedural, clinical and QoL outcomes of TAVI. Material and methods A total of 101 consecutive patients undergoing TAVI were enrolled. Patients were stratified by gender. Baseline characteristics, procedural and long-term clinical outcomes as well as frailty and QoL indices (EQ-5D-3L questionnaire) were compared between women and men. Results Women represented 60.4% of the study population. Periprocedural risk measured with the Logistic EuroSCORE and STS scale was similar for women and men. There were no differences in 30-day or 12-month all-cause mortality between groups (women vs. men: 9.8% vs. 12.5%; age-adjusted odds ratio (OR) (95% CI): 1.38 (0.39–4.94); 13.1% vs. 25.0%; age-adjusted OR (95% CI): 2.51 (0.87–7.25)). Men were at higher risk of new onset atrial fibrillation at follow-up (1.6% vs. 17.5%; age-adjusted OR (95% CI): 14.61 (1.68–127.37)). In multivariable Cox regression analysis, a history of stroke/transient ischemic attack (TIA) (hazard ratio (HR)) (95% CI): 3.93 (1.39–11.07) and blood transfusion (HR (95% CI): 2.84 (1.06–7.63)) were identified as independent factors affecting 12-month mortality. No differences in QoL parameters were noted. Conclusions The TAVI can be considered as an effective and safe treatment in high-risk patients with severe aortic stenosis, regardless of gender.
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Meucci F, Stefàno P, Di Mario C. Unlike for PCI, for TAVR smaller is better. Int J Cardiol 2017; 240:157-158. [PMID: 28606675 DOI: 10.1016/j.ijcard.2017.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 03/06/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Francesco Meucci
- Structural Interventional Cardiology, University Hospital Careggi, Florence, Italy
| | - Pierluigi Stefàno
- Cardiovascular Surgery, University Hospital Careggi, Florence, Italy
| | - Carlo Di Mario
- Structural Interventional Cardiology, University Hospital Careggi, Florence, Italy.
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29
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Dimitriadis Z, Scholtz W, Börgermann J, Wiemer M, Piper C, Vlachojannis M, Gummert J, Horstkotte D, Ensminger S, Faber L, Scholtz S. Impact of closure devices on vascular complication and mortality rates in TAVI procedures. Int J Cardiol 2017; 241:133-137. [DOI: 10.1016/j.ijcard.2017.01.088] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 12/15/2016] [Accepted: 01/13/2017] [Indexed: 12/17/2022]
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30
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Chen J, Hahn RT. Sex-Related Differences in the Physiology, Risk, and Outcomes of Transcatheter Aortic Valve Replacement. GENDER AND THE GENOME 2017. [DOI: 10.1089/gg.2016.0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Transcatheter aortic valve replacement (TAVR) is a less-invasive alternative to surgical aortic valve replacement (SAVR) for the management of symptomatic severe aortic stenosis in patients with inoperable, high, or intermediate surgical risk. Females undergoing TAVR exhibit distinct physiology and baseline characteristics from their male counterparts. Although rates of procedural complications are higher, medium-term survival appears better for females than males. These sex-based differences are discussed in depth in this review of TAVR in the female population.
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Affiliation(s)
- Jennifer Chen
- Columbia University Medical Center/New York–Presbyterian Hospital, New York, New York
| | - Rebecca T. Hahn
- Columbia University Medical Center/New York–Presbyterian Hospital, New York, New York
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31
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Skelding KA, Yakubov SJ, Kleiman NS, Reardon MJ, Adams DH, Huang J, Forrest JK, Popma JJ. Transcatheter Aortic Valve Replacement Versus Surgery in Women at High Risk for Surgical Aortic Valve Replacement (from the CoreValve US High Risk Pivotal Trial). Am J Cardiol 2016; 118:560-6. [PMID: 27381665 DOI: 10.1016/j.amjcard.2016.05.051] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 05/13/2016] [Accepted: 05/13/2016] [Indexed: 11/26/2022]
Abstract
The objective of this study was to compare outcomes in women after surgical aortic valve replacement (SAVR) versus transcatheter aortic valve replacement (TAVR) using a self-expanding prosthesis in patients with severe aortic stenosis who were at high risk for SAVR. Although registries and meta-analyses have suggested that TAVR is of considerable benefit in women, perhaps even more so than in men, a rigorous evaluation of TAVR with a self-expanding valve versus SAVR in women from a randomized trial has not been performed. Patients with severe aortic stenosis were randomized 1:1 to either TAVR or SAVR. Outcomes at 1 year are reported. Treatment was attempted in a total of 353 women (183 TAVR and 170 SAVR). Baseline characteristics and predicted risk of the 2 groups were comparable, although the frequency of diabetes mellitus was lower in patients undergoing TAVR (33.3% vs 45.3%; p = 0.02). TAVR-treated patients experienced a statistically significant 1-year survival advantage compared with SAVR patients (12.7% vs 21.8%; p = 0.03). The composite all-cause mortality or major stroke rate also favored TAVR (14.9% vs 24.2%; p = 0.04). Quality of life, as measured by the Kansas City Cardiomyopathy Questionnaire summary score, for both the TAVR and SAVR groups increased significantly from baseline to 1 year. In conclusion, female TAVR patients had lower 1-year mortality and lower 1-year all-cause mortality or major stroke compared with women undergoing SAVR, with both cohorts experiencing improved quality of life. Further studies specifically in women are warranted to validate these findings.
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Naoum C, Blanke P, Dvir D, Pibarot P, Humphries K, Webb J, Leipsic J. Clinical Outcomes and Imaging Findings in Women Undergoing TAVR. JACC Cardiovasc Imaging 2016; 9:483-93. [DOI: 10.1016/j.jcmg.2016.02.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 02/12/2016] [Accepted: 02/18/2016] [Indexed: 01/09/2023]
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33
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Harjai KJ, Grines CL, Leon MB. Transcatheter Aortic Valve Replacement: 2015 in Review. J Interv Cardiol 2016; 29:27-46. [DOI: 10.1111/joic.12274] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Kishore J. Harjai
- Geisinger Clinic; Pearsall Heart Hospital; Wilkes-Barre Pennsylvania
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34
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Montone RA, Testa L, Bedogni F. Outcomes After Transcatheter Aortic Valve Replacement With Balloon-Expandable Versus Self-Expandable Valves: CHOICE Trial Results. J Am Coll Cardiol 2016; 67:235-236. [PMID: 26791073 DOI: 10.1016/j.jacc.2015.08.1133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 08/27/2015] [Indexed: 10/22/2022]
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35
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Regitz-Zagrosek V, Oertelt-Prigione S, Prescott E, Franconi F, Gerdts E, Foryst-Ludwig A, Maas AHEM, Kautzky-Willer A, Knappe-Wegner D, Kintscher U, Ladwig KH, Schenck-Gustafsson K, Stangl V. Gender in cardiovascular diseases: impact on clinical manifestations, management, and outcomes. Eur Heart J 2015; 37:24-34. [PMID: 26530104 DOI: 10.1093/eurheartj/ehv598] [Citation(s) in RCA: 420] [Impact Index Per Article: 46.7] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 10/12/2015] [Indexed: 01/08/2023] Open
Affiliation(s)
| | - Vera Regitz-Zagrosek
- Institute of Gender in Medicine, Center for Cardiovascular Research, Charité - Universitätsmedizin Berlin, Hessische Str. 3-4, 10115 Berlin, Germany International Society for Gender Medicine DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany
| | - Sabine Oertelt-Prigione
- Institute of Gender in Medicine, Center for Cardiovascular Research, Charité - Universitätsmedizin Berlin, Hessische Str. 3-4, 10115 Berlin, Germany International Society for Gender Medicine DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany
| | - Eva Prescott
- Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
| | - Flavia Franconi
- International Society for Gender Medicine Dep Scienze Biomediche, Regione Basilicata and National Laboratory of Gender Medicine, Consorzio Interuniversitario INBB, University of Sassari, Via Muroni 23a, 07100 Sassari, Italy
| | - Eva Gerdts
- Department of Clinical Science, University of Bergen, PO Box 7804, 5020 Bergen, Norway
| | - Anna Foryst-Ludwig
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany Institute of Pharmacology, Center for Cardiovascular Research, Charité - Universitätsmedizin Berlin, Hessische Str. 3-4, 10115 Berlin, Germany
| | - Angela H E M Maas
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein-Zuid 10, Route 616, 6525 GA Nijmegen, The Netherlands
| | - Alexandra Kautzky-Willer
- International Society for Gender Medicine Gender Medicine Unit, Internal Medicine III, Endocrinology, Medical University of Vienna, International Society for Gender Medicine, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Dorit Knappe-Wegner
- International Society for Gender Medicine University Heart Center Hamburg, Martinistrasse 52, 20246 Hamburg, Germany
| | - Ulrich Kintscher
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany Institute of Pharmacology, Center for Cardiovascular Research, Charité - Universitätsmedizin Berlin, Hessische Str. 3-4, 10115 Berlin, Germany
| | - Karl Heinz Ladwig
- Helmholtz Center Munich, Institute of Epidemiology II, German Research Center for Environmental Health, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
| | - Karin Schenck-Gustafsson
- International Society for Gender Medicine Karolinska Institutet Stockholm, Centre for Gender Medicine, Thorax N3:05, International Society for Gender Medicine, 17176 Stockholm, Sweden
| | - Verena Stangl
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany Clinic for Cardiology and Angiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
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Abaunza M, Kabbani LS, Nypaver T, Greenbaum A, Balraj P, Qureshi S, Alqarqaz MA, Shepard AD. Incidence and prognosis of vascular complications after percutaneous placement of left ventricular assist device. J Vasc Surg 2015; 62:417-23. [DOI: 10.1016/j.jvs.2015.03.040] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 03/18/2015] [Indexed: 11/25/2022]
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Abstract
Transcatheter aortic valve replacement (TAVR) has transformed the management of severe aortic stenosis for high-risk and inoperable patients. The 10-year experience in Europe has proven the technology to be safe and effective in select populations. The PARTNER trial, the first prospective, randomized, controlled trial for TAVR, showed the technology to be superior to medical management for inoperable patients and equivalent to surgical aortic valve replacement for high-risk patients. Research in cardiovascular medicine has been dominated by studies on the male sex, due to the incidence of the disease process and partly due to historic predominance of male subjects in research studies. Alternatively, TAVR studies focused on high-risk and inoperable patients who are equally distributed by sex. Although sex-related differences are apparent in their baseline characteristics, outcomes have been mixed, with evidence suggesting that female patients may have a mortality advantage with TAVR. Herein we review the TAVR procedure and devices currently available and focus our discussion on outcomes after transcatheter or surgical aortic valve replacement in patients with severe aortic stenosis.
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38
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Szerlip M, Holper E. Editorial: Sex and TAVR: game, set, match to women. J Interv Cardiol 2014; 27:540-1. [PMID: 25421834 DOI: 10.1111/joic.12163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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