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Rivera FB, Cha SW, Redula SC, Liston MBO, Ong EP, Bantayan NRB, Kaur G, Volgman AS, Mamas MA. Sex differences in transcatheter aortic valve replacement outcomes among patients with bicuspid aortic stenosis. Heart Lung 2024; 67:144-151. [PMID: 38762962 DOI: 10.1016/j.hrtlng.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/22/2024] [Accepted: 05/06/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND Despite comprising almost half of all patients undergoing valvular repair, data on transcatheter aortic valve replacement (TAVR) in patients with bicuspid aortic stenosis (BAS) are limited. OBJECTIVE We aimed to evaluate whether there are any sex differences in trends and outcomes of TAVR in this population. METHODS We utilized the National Inpatient Sample from 2012 to 2020 to identify admissions with BAS who underwent TAVR and analyzed trends and outcomes. Our primary outcome was in-hospital mortality and secondary outcomes were in-hospital complications. We used two models to adjust for demographics (A) and interventions (B). RESULTS Between 2012 to 2020, there were 76,540 hospitalizations for BAS patients who underwent AVR, among which 6,010 (7.9 %) underwent TAVR. There was an overall increasing trend in number of TAVR cases with a decreasing trend in mortality (2013: 8.7 %, 2020: 1.3 %). TAVR was performed more in males (61.1% vs 38.9 %). Despite the worse baseline characteristics in males, in-hospital mortality (2.4% vs. 1.5 %; OR: 1.584; 95 % CI: 0.621-4.038; p = 0.335) and secondary outcomes were similar across both sexes, even after adjusting for demographics and interventions. CONCLUSION TAVR in BAS has grown rapidly in the last decade. Males comprised the majority and had more comorbidities, but mortality and complications were similar in both sexes. Despite the increasing number of cases, a decreasing trend in mortality was observed for both sexes ultimately approaching that of SAVR, suggesting that TAVR may be a safe alternative among eligible males and females with bicuspid AS.
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Affiliation(s)
| | | | | | | | - Erika P Ong
- University of the Philippines Manila, Manila City, Philippines
| | | | - Gurleen Kaur
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Mamas A Mamas
- Keele Cardiovascular Research Group, Center for Prognosis Research, Keele University, Stoke-on-Trent, UK
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2
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Lodo V, Italiano EG, Weltert L, Zingarelli E, Perrucci C, Pietropaolo C, Buono G, Centofanti P. The influence of gender on outcomes following transcatheter aortic valve implantation. Front Cardiovasc Med 2024; 11:1417430. [PMID: 39087077 PMCID: PMC11288807 DOI: 10.3389/fcvm.2024.1417430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Accepted: 07/01/2024] [Indexed: 08/02/2024] Open
Abstract
Objectives This study aimed to compare gender-related differences in short- and long-term outcomes after transcatheter aortic valve implantation. Methods Patients who underwent transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS) from September 2017 to December 2022 were enrolled. The primary endpoint was 5-year all-cause mortality. The secondary endpoints were 30-day mortality and the incidence of post-procedural complication. Patients were separated according to gender before statistical analysis. To compare patients with similar baseline characteristics, we performed a propensity matching. Results A total of 704 patients [females, 361 (51.3%); males, 343 (48.7%)] were enrolled. Compared to women, men had a higher incidence of smoking (40.5% vs. 14.7%, p < 0.001), diabetes (32.9% vs. 25.1%, p < 0.025), peripheral artery disease (35.8% vs. 18.3%, p < 0.001), and previous cardiac surgery (13.7% vs. 7.2%, p = 0.006) and a lower ejection fraction [56.6 (9.3) vs. 59.8 (7.5), p = 0.046]. Female patients were frailer at the time of the procedure [poor mobility rate, 26% vs. 11.7%, p < 0.001; CCI (Charlson comorbidity index) 2.4 (0.67) vs. 2.32 (0.63), p = 0.04]. Despite these different risk profiles, no significant differences were reported in terms of post-procedural outcomes and long-term survival. Propensity score matching resulted in a good match of 204 patients in each group (57.9% of the entire study population). In the matched cohort, men had a significantly higher incidence of new pacemaker implantation compared to women [33 (16.2%) vs. 18 (8.8%)]. The Kaplan-Meier 5-year survival estimate was 82.4% for women and 72.1% for men, p = 0.038. Conclusions Female gender could be considered as a predictor of better outcomes after TAVI.
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Affiliation(s)
- Vittoria Lodo
- Department of Cardiac Surgery, Azienda Ospedaliera Ordine Mauriziano di Torino, Turin, Italy
| | - Enrico G. Italiano
- Division of Cardiac Surgery, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Luca Weltert
- Department of Cardiovascular Sciences, European Hospital, Rome, Italy
| | - Edoardo Zingarelli
- Department of Cardiac Surgery, Azienda Ospedaliera Ordine Mauriziano di Torino, Turin, Italy
| | - Chiara Perrucci
- Department of Cardiovascular Anesthesia and Intensive Care, Azienda Ospedaliera Ordine Mauriziano, Turin, Italy
| | - Claudio Pietropaolo
- Department of Cardiovascular Anesthesia and Intensive Care, Azienda Ospedaliera Ordine Mauriziano, Turin, Italy
| | - Gabriella Buono
- Department of Cardiovascular Anesthesia and Intensive Care, Azienda Ospedaliera Ordine Mauriziano, Turin, Italy
| | - Paolo Centofanti
- Department of Cardiac Surgery, Azienda Ospedaliera Ordine Mauriziano di Torino, Turin, Italy
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3
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Tateishi K, Hmoud H, De Gregorio I, Hastings R, De Gregorio J. The impact of gender on outcomes of transcatheter aortic valve implantation between self-expanding valve and balloon-expandable valve. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 63:38-42. [PMID: 38216339 DOI: 10.1016/j.carrev.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 01/03/2024] [Indexed: 01/14/2024]
Abstract
BACKGROUND While females have been found to have a higher rate of procedural complications with transcatheter aortic valve implantation (TAVI) than males, the effect of valve choice has not been fully elucidated. This study aimed to investigate the impact of gender and choice of balloon or self-expanding valve on TAVI complications. METHODS Data from patients who received a TAVI in our institution from January 2016 to September 2021 were retrospectively analyzed. A total of 971 patients were included and divided into self-expanding valve (n = 315) and balloon-expandable valve (n = 656) groups. The endpoints were 30-day mortality, need for a new pacemaker, and major adverse cardiovascular events (MACE) which is defined as cardiac arrest, stroke, myocardial infarction, major bleeding, and unplanned vascular surgery/intervention. RESULTS There were more females in the self-expanding valve group than in the balloon-expandable valve group (64.1 % vs. 43.6 %: p < 0.0001). There is no significant difference in the prevalence of hypertension, diabetes mellitus, current smoker, hemodialysis, and the STS risk score between the 2 groups. Females had a higher rate of major adverse cardiovascular events (3.7 % in men vs. 6.8 % in women; p = 0.043), which was driven mostly by vascular complications. This difference was particularly observed in the self-expanding valve group (2.7 % in men vs. 9.4 % in women; p = 0.036). CONCLUSIONS TAVI complications were more common in females than males, driven mostly by vascular complications. This difference was particularly observed in woman treated with a self-expanding valve. Particular attention should be given to access choices in females undergoing TAVI.
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Affiliation(s)
- Kazuya Tateishi
- Department of Cardiovascular Services, Englewood Hospital and Medical Center, Englewood, NJ, USA.
| | - Hosam Hmoud
- Department of Cardiology, Lenox Hill Hospital Northwell Health, New York, NY, USA
| | | | - Ramin Hastings
- Department of Cardiovascular Services, Englewood Hospital and Medical Center, Englewood, NJ, USA
| | - Joseph De Gregorio
- Department of Cardiovascular Services, Englewood Hospital and Medical Center, Englewood, NJ, USA
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4
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Adamo M, Branca L, Pezzola E, Saia F, Pilgrim T, Abdel-Wahab M, Garot P, Gandolfo C, Fiorina C, Sammartino S, Latib A, Santos IA, Mylotte D, De Marco F, De Backer O, Franco LN, Akodad M, Ribichini FL, Bedogni F, Laterra G, Mazzapicchi A, Tomii D, Laforgia P, Cannata S, Scotti A, Fezzi S, Criscione E, Poletti E, Mazzucca M, Valvo R, Lunardi M, Mainardi A, Andreaggi S, Quagliana A, Montarello N, Hennessey B, Mon-Noboa M, Meier D, Sgroi C, Reddavid CM, Strazzieri O, Motta SC, Frittitta V, Dipietro E, Comis A, Melfa C, Cal M, Thiele H, Webb JG, Søndergaard L, Tamburino C, Metra M, Costa G, Barbanti M. Sex-Related Outcomes of Transcatheter Aortic Valve Implantation With Self-Expanding or Balloon-Expandable Valves: Insights from the OPERA-TAVI Registry. Am J Cardiol 2024; 219:60-70. [PMID: 38401656 DOI: 10.1016/j.amjcard.2024.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/30/2023] [Accepted: 01/22/2024] [Indexed: 02/26/2024]
Abstract
Evidence regarding gender-related differences in response to transcatheter aortic valve implantation according to the valve type is lacking. This study aimed to evaluate the impact of gender on the treatment effect of Evolut PRO/PRO+ (PRO) or SAPIEN 3 Ultra (ULTRA) devices on clinical outcomes. The Comparative Analysis of Evolut PRO vs SAPIEN 3 Ultra Valves for Transfemoral Transcatheter Aortic Valve Implantation (OPERA-TAVI) is a multicenter, multinational registry including patients who underwent the latest-iteration PRO or ULTRA implantation. Overall, 1,174 of 1,897 patients were matched based on valve type and compared according to gender, whereas 470 men and 630 women were matched and compared according to valve type. The 30-day and 1-year outcomes were evaluated. In the PRO and ULTRA groups, men had a higher co-morbidity burden, whereas women had smaller aortic root. The 30-day (device success [DS], early safety outcome, permanent pacemaker implantation, patient-prosthesis mismatch, paravalvular regurgitation, bleedings, vascular complications, and all-cause death) and 1-year outcomes (all-cause death, stroke, and heart failure hospitalization) did not differ according to gender in both valve groups. However, the male gender decreased the likelihood of 30-day DS with ULTRA versus PRO (p for interaction = 0.047). A higher risk of 30-day permanent pacemaker implantation and 1-year stroke and a lower risk of patient-prosthesis mismatch was observed in PRO versus ULTRA, regardless of gender. In conclusion, gender did not modify the treatment effect of PRO versus ULTRA on clinical outcomes, except for 30-day DS, which was decreased in men (vs women) who received ULTRA (vs PRO).
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Affiliation(s)
- Marianna Adamo
- Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
| | - Luca Branca
- Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Elisa Pezzola
- Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Francesco Saia
- Cardiovascular Department, Policlinico S. Orsola, University of Bologna, Bologna, Italy
| | - Thomas Pilgrim
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - Mohamed Abdel-Wahab
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Science, Leipzig, Germany
| | - Philippe Garot
- Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Jacques Cartier, Ramsay-Santé, Massy, France
| | - Caterina Gandolfo
- Istituto Mediterraneo per i Trapianti e Terapie ad Alta specializzazione (ISMETT), Palermo, Italy
| | - Claudia Fiorina
- Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Sofia Sammartino
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco," Catania, Italy
| | - Azeem Latib
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Ignacio Amat Santos
- Division of Cardiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Darren Mylotte
- Department of Cardiology, University Hospital, University of Galway, Ireland
| | - Federico De Marco
- Interventional Cardiology Department, IRCSS Centro Cardiologico Monzino, Milan, Italy
| | - Ole De Backer
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Mariama Akodad
- Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Jacques Cartier, Ramsay-Santé, Massy, France; Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Francesco Bedogni
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese (MI), Italy
| | | | | | - Daijiro Tomii
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - Pietro Laforgia
- Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Jacques Cartier, Ramsay-Santé, Massy, France
| | - Stefano Cannata
- Istituto Mediterraneo per i Trapianti e Terapie ad Alta specializzazione (ISMETT), Palermo, Italy
| | - Andrea Scotti
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Simone Fezzi
- Department of Cardiology, University Hospital, University of Galway, Ireland
| | - Enrico Criscione
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese (MI), Italy
| | - Enrico Poletti
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese (MI), Italy
| | - Mattia Mazzucca
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese (MI), Italy
| | - Roberto Valvo
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese (MI), Italy
| | - Mattia Lunardi
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Andrea Mainardi
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Stefano Andreaggi
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Angelo Quagliana
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nicholas Montarello
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | - David Meier
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Carmelo Sgroi
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco," Catania, Italy
| | | | - Orazio Strazzieri
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco," Catania, Italy
| | | | - Valentina Frittitta
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco," Catania, Italy
| | - Elena Dipietro
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco," Catania, Italy
| | - Alessandro Comis
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco," Catania, Italy
| | - Chiara Melfa
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco," Catania, Italy
| | - Mariachiara Cal
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco," Catania, Italy
| | - Holger Thiele
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Science, Leipzig, Germany
| | - John G Webb
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lars Søndergaard
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Corrado Tamburino
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco," Catania, Italy
| | - Marco Metra
- Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Giuliano Costa
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco," Catania, Italy
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5
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Srinivasan A, Wong F, Wang B. Transcatheter aortic valve replacement: Past, present, and future. Clin Cardiol 2024; 47:e24209. [PMID: 38269636 PMCID: PMC10788655 DOI: 10.1002/clc.24209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 12/15/2023] [Accepted: 12/20/2023] [Indexed: 01/26/2024] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has emerged as a ground-breaking, minimally invasive alternative to traditional open-heart surgery, primarily designed for elderly patients initially considered unsuitable for surgical intervention due to severe aortic stenosis. As a result of successful large-scale trials, TAVR is now being routinely applied to a broader spectrum of patients. In deciding between TAVR and surgical aortic valve replacement, clinicians evaluate various factors, including patient suitability and anatomy through preprocedural imaging, which guides prosthetic valve sizing and access site selection. Patient surgical risk is a pivotal consideration, with a multidisciplinary team making the ultimate decision in the patient's best interest. Periprocedural imaging aids real-time visualization but is influenced by anaesthesia choices. A comprehensive postprocedural assessment is critical due to potential TAVR-related complications. Numerous trials have demonstrated that TAVR matches or surpasses surgery for patients with diverse surgical risk profiles, ranging from extreme to low risk. However, long-term follow-up data, particularly in low-risk cases, remains limited, and the applicability of published results to younger patients is uncertain. This review delves into key TAVR studies, pinpointing areas for potential improvement while delving into the future of this innovative procedure. Furthermore, it explores the expanding role of TAVR technology in addressing other heart valve replacement procedures.
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Affiliation(s)
- Akash Srinivasan
- Division of Medical Sciences, Nuffield Department of Surgical SciencesUniversity of OxfordOxfordUK
| | - Felyx Wong
- Guy's and St Thomas’ NHS Foundation TrustLondonUK
| | - Brian Wang
- Department of Metabolism, Digestion and Reproduction, Faculty of MedicineImperial College LondonLondonUK
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Paitazoglou C, Eitel I, Stiermaier T, Ince H, Kische S, Pokushalov E, Schmitz T, Schmidt B, Gori T, Meincke F, Vireca E, Wohlmuth P, Lucas B, Bergmann MW. Sex-related differences in outcome after left atrial appendage occlusion: Insights from Europe and the EWOLUTION registry. Catheter Cardiovasc Interv 2023. [PMID: 37393575 DOI: 10.1002/ccd.30759] [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: 12/14/2022] [Revised: 05/18/2023] [Accepted: 06/18/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Women with atrial fibrillation (AF) generally experience worse symptoms, poorer quality of life, and have a higher risk of stroke and death. There is limited availability of sex-related differences regarding left atrial appendage occlusion (LAAO). AIMS The aim of this study was to evaluate the sex-related differences in patients undergoing LAAO in EWOLUTION. METHODS A total of 1025 patients scheduled for elective LAAO therapy employing the WATCHMAN Gen 2.5 prospectively consented for participation; 1005 patients received a successful implant and were followed for 2 years. As we detected sex-related differences in baseline data we performed a propensity score matching. The primary endpoint is a combined endpoint of survival free from mortality, major bleeding, ischemic stroke, transitory ischemic attack (TIA) and systemic embolization (SE) up to 2-year clinical follow-up. Secondary Endpoints were periprocedural data and overall 2-year survival. RESULTS Women were older but had less often vascular disease and hemorrhagic stroke. There was no sex-related significant difference after LAAO at 2 years in the combined endpoint of survival free from mortality, major bleeding, ischemic stroke, TIA, and SE (female vs. male: 79% vs.76%, p = 0.24) or in overall survival (female vs. male: 85% vs. 82%, p = 0.16). Procedural data showed a higher sealing rate after the implantation in women (complete sealing female 94% vs. male 90%, p = 0.033), significantly more pericardial effusions (female 1.2% vs. male 0.2%, p = 0.031) and a similar periprocedural risk profile. CONCLUSIONS Females undergoing LAAO differ in various baseline variables, but after adjustment, we observed similar safety and efficacy of LAAO with no significant difference in long-term outcomes between women and men.
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Affiliation(s)
- Christina Paitazoglou
- Department Medical Clinic II (Cardiology, Angiology, Intensive Care Medicine), University Schleswig-Holstein (UKSH), University Heart Center Lübeck, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg-Kiel-Lübeck, Lübeck, Germany
| | - Ingo Eitel
- Department Medical Clinic II (Cardiology, Angiology, Intensive Care Medicine), University Schleswig-Holstein (UKSH), University Heart Center Lübeck, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg-Kiel-Lübeck, Lübeck, Germany
| | - Thomas Stiermaier
- Department Medical Clinic II (Cardiology, Angiology, Intensive Care Medicine), University Schleswig-Holstein (UKSH), University Heart Center Lübeck, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg-Kiel-Lübeck, Lübeck, Germany
| | - Hueseyin Ince
- Department of Cardiology, Vivantes Klinikum Neukölln and Klinikum Am Urban, Berlin, Germany
- Department of Cardiology, University Rostock, Rostock, Germany
| | - Stephan Kische
- Department of Cardiology, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Evgeny Pokushalov
- Department of Cardiology, E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russia
| | - Thomas Schmitz
- Department of Cardiology, Elisabeth Krankenhaus, Essen, Germany
| | - Boris Schmidt
- Department of Cardiology, Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | - Tommaso Gori
- Department of Cardiology, Universitätsmedizin Mainz und DZHK Standort Rhein-Main, Mainz, Germany
| | | | | | | | - Boersma Lucas
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
- Amsterdam UMV, Amsterdam, The Netherlands
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7
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Golemi L, Kumar S, Ahmad A, Ghani A, Srinivasamurthy R, Kumari S, Nasir A, Harjai K. Sex-Based Outcomes in Patients Undergoing WATCHMAN Device Implantation. Am J Cardiol 2023; 201:58-61. [PMID: 37352665 DOI: 10.1016/j.amjcard.2023.05.037] [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: 01/04/2023] [Revised: 05/19/2023] [Accepted: 05/21/2023] [Indexed: 06/25/2023]
Abstract
Sex-based disparities in outcomes are reported for various cardiovascular procedures. This study aimed to assess the difference in outcomes in patients who underwent WATCHMAN device implant based on sex. Patients who underwent WATCHMAN device placement, from 2016 to 2018, were identified from the National Inpatient Sample database. The primary outcome was inpatient mortality, and the secondary outcomes were the length of stay (LOS), hospitalization cost (HOC), and periprocedural complications. A logistic regression model was built to perform an adjusted analysis for the outcomes. A total of 12,327 patients underwent WATCHMAN device placement. Female patients were older and more likely to have hypertension (p <0.01) and less likely to have peripheral arterial disease (5.6 vs 7.2, p <0.01), chronic kidney disease (21% vs 26%, p <0.01), and diabetes (18% vs 20%, p = 0.03) and were also at a higher risk for certain periprocedural complications, including pericardiocentesis and anemia requiring blood transfusion (p <0.01 for all). In the unadjusted analysis, the female sex was associated with longer LOS (1.5 vs 1.3 days, p <0.01) and inpatient mortality (0.23 vs 0.10, p = 0.05). The HOC was numerically higher in women but statistically nonsignificant ($120,791 vs $118,554, p = 0.1). In the stepwise, backward, multivariate regression analysis, the female sex was an independent risk factor for higher LOS (1.5 vs 1.3 days, p <0.01, 95% confidence interval 1.3 to 1.4) after adjusting for potential confounders. The inpatient mortality and HOC were similar between 2 groups after adjusting for potential cofounders in the multivariate regression analysis. Our study suggests that the female sex is an independent risk factor for longer LOS among patients hospitalized for WATCHMAN device placement.
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Affiliation(s)
- Lolita Golemi
- Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Sundeep Kumar
- Division of Cardiology, Case Western Reserve University, Cleveland, Ohio
| | - Ali Ahmad
- Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Ali Ghani
- Division of Cardiology, University of Connecticut, Farmington, Connecticut
| | | | - Sarika Kumari
- Division of Cardiology, Jinnah Post Graduate Medical Center, Karachi, Pakistan
| | - Ammar Nasir
- Division of Cardiology, St. Louis University Hospital, St. Louis, Missouri
| | - Kishore Harjai
- Division of Cardiology, St. Louis University Hospital, St. Louis, Missouri.
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8
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Elbaz-Greener G, Rahamim E, Abu Ghosh Z, Carasso S, Yarkoni M, Radhakrishnan S, Wijeysundera HC, Igor T, Planer D, Rozen G, Amir O. Sex difference and outcome trends following transcatheter aortic valve replacement. Front Cardiovasc Med 2022; 9:1013739. [PMID: 36329995 PMCID: PMC9623151 DOI: 10.3389/fcvm.2022.1013739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 09/08/2022] [Indexed: 01/09/2023] Open
Abstract
Background Based on worldwide registries, approximately 50% of patients who underwent transcatheter aortic valve replacement (TAVR) are female patients. Although TAVR procedures have improved tremendously in recent years, differences in outcome including mortality between sexes remain. We aimed to investigate the trends in TAVR in the early and new eras of utilization and to assess TAVR outcomes in female patients vs. male patients. Methods Using the 2011–2017 National Inpatient Sample (NIS) database, we identified hospitalizations for patients with the diagnosis of aortic stenosis during which a TAVR was performed. Patients' sociodemographic and clinical characteristics, procedure complications, and mortality were analyzed. Piecewise regression analyses were performed to assess temporal trends in TAVR utilization in female patients and in male patients. Multivariable analysis was performed to identify predictors of in-hospital mortality. Results A total of 150,647 hospitalizations for TAVR across the United States were analyzed during 2011–2017. During the study period, a steady upward trend was observed for TAVR procedures in both sexes. From 2011 to 2017, there were significantly more TAVR procedures performed in men [80,477 (53.4%)] than in women [70,170 (46.6%)]. Male patients had significantly higher Deyo-CCI score and comorbidities. Differences in mortality rates among sexes were observed, presenting with higher in-hospital mortality in women than in men, OR 1.26 [95% CI 1.18–1.35], p < 0.001. Conclusion Utilization of TAVR demonstrated a steady upward trend during 2011–2017, and a similar trend was presented for both sexes. Higher in-hospital mortality was recorded in female patients compared to male patients. Complication rates decreased over the years but without effect on mortality differences between the sex groups.
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Affiliation(s)
- Gabby Elbaz-Greener
- Department of Cardiology, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- *Correspondence: Gabby Elbaz-Greener
| | - Eldad Rahamim
- Department of Cardiology, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Zahi Abu Ghosh
- Department of Cardiology, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Shemy Carasso
- Division of Cardiovascular Medicine, Baruch Padeh Medical Center, Poria, Israel
- The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Merav Yarkoni
- Department of Cardiology, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sam Radhakrishnan
- Schulich Heart Program, Division of Cardiology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Harindra C. Wijeysundera
- Schulich Heart Program, Division of Cardiology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Tomas Igor
- Institute for Cardiovascular Disease of Vojvodina, Sremska Kamenica Institute, Belgrade, Serbia
| | - David Planer
- Department of Cardiology, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Guy Rozen
- Cardiovascular Center, Tufts Medical Center, Boston, MA, United States
- Tufts University School of Medicine, Boston, MA, United States
- Cardiac Arrhythmia Center, Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States
| | - Offer Amir
- Department of Cardiology, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
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9
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Masiero G, Paradies V, Franzone A, Bellini B, De Biase C, Karam N, Sanguineti F, Mamas MA, Eltchaninoff H, Fraccaro C, Castiglioni B, Attisano T, Esposito G, Chieffo A. Sex-Specific Considerations in Degenerative Aortic Stenosis for Female-Tailored Transfemoral Aortic Valve Implantation Management. J Am Heart Assoc 2022; 11:e025944. [PMID: 36172929 DOI: 10.1161/jaha.121.025944] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The impact of sex on pathophysiological processes, clinical presentation, treatment options, as well as outcomes of degenerative aortic stenosis remain poorly understood. Female patients are well represented in transfemoral aortic valve implantation (TAVI) trials and appear to derive favorable outcomes with TAVI. However, higher incidences of major bleeding, vascular complications, and stroke have been reported in women following TAVI. The anatomical characteristics and pathophysiological features of aortic stenosis in women might guide a tailored planning of the percutaneous approach. We highlight whether a sex-based TAVI management strategy might impact on clinical outcomes. This review aimed to evaluate the impact of sex from diagnosis to treatment of degenerative aortic stenosis, discussing the latest evidence on epidemiology, pathophysiology, clinical presentation, therapeutic options, and outcomes. Furthermore, we focused on technical sex-oriented considerations in TAVI including the preprocedural screening, device selection, implantation strategy, and postprocedural management.
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Affiliation(s)
- Giulia Masiero
- Department of Cardiac, Thoracic Vascular Science and Public Health, University of Padova Italy
| | - Valeria Paradies
- Department of Cardiology Maasstad Hospital Rotterdam The Netherlands
| | - Anna Franzone
- Department of Advanced Biomedical Sciences Federico II University of Naples Italy
| | - Barbara Bellini
- Interventional Cardiology Unit IRCCS San Raffaele Scientific Institute Milan Italy
| | - Chiara De Biase
- Groupe CardioVasculaire Interventionnel Clinique Pasteur Toulouse France
| | - Nicole Karam
- Cardiology Department European Hospital Georges Pompidou Paris France
| | | | - Mamas A Mamas
- Keele Cardiovascular Research Group School of Medicine, Keele University Stoke-on-Trent United Kingdom.,Department of Cardiology Royal Stoke University Hospital Stoke-on-Trent United Kingdom.,Department of Medicine Thomas Jefferson University Philadelphia PA
| | | | - Chiara Fraccaro
- Department of Cardiac, Thoracic Vascular Science and Public Health, University of Padova Italy
| | | | - Tiziana Attisano
- Division of Interventional Cardiology Cardiovascular and Thoracic Department, San Giovanni di Dio e Ruggi Salerno Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences Federico II University of Naples Italy
| | - Alaide Chieffo
- Interventional Cardiology Unit IRCCS San Raffaele Scientific Institute Milan Italy
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10
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The Evolution of Pulmonary Hypertension and Its Prognostic Implications Post-TAVI-Single Center Experience. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58091182. [PMID: 36143859 PMCID: PMC9501961 DOI: 10.3390/medicina58091182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/25/2022] [Accepted: 08/26/2022] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Since the first transcatheter aortic valve implantation (TAVI) procedure was performed in 2002, advances in technology and refinement of the method have led to its widespread use in patients with severe aortic stenosis (AS) and high surgical risk. We aim to identify the impact of TAVI on the clinical and functional status of patients with severe AS at the one-month follow-up and to identify potential predictors associated with the evolution of pulmonary hypertension (PH) in this category of patients. Materials and Methods: We conducted a prospective study which included 86 patients diagnosed with severe AS undergoing TAVI treatment. We analyzed demographics, clinical and echocardiographic parameters associated with AS and PH both at enrolment and at the 30-day follow-up. Results: In our study, the decrease of EUROSCORE II score (p < 0.001), improvement of angina (p < 0.001) and fatigue (p < 0.001) as clinical benefits as well as a reduction in NYHA functional class in patients with heart failure (p < 0.001) are prognostic predictors with statistical value. Regression of left ventricular hypertrophy (p = 0.001), increase in the left ventricle ejection fraction (p = 0.007) and improvement of diastolic dysfunction (p < 0.001) are echocardiographic parameters with a prognostic role in patients with severe AS undergoing TAVI. The pulmonary artery acceleration time (PAAT) (p < 0.001), tricuspid annular plane systolic excursion (TAPSE) (p = 0.020), pulmonary arterial systolic pressure (PASP) (p < 0.001) and the TAPSE/PASP ratio (p < 0.001) are statistically significant echocardiographic parameters in our study that assess both PH and its associated prognosis in patients undergoing TAVI. Conclusions: PAAT, TAPSE, PASP and the TAPSE/PASP ratio are independent predictors that allow the assessment of PH and its prognostic implications post-TAVI.
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11
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Gender difference in left atrial appendage occlusion outcomes: Results from the Amplatzer™ Amulet™ Observational Study. IJC HEART & VASCULATURE 2021; 35:100848. [PMID: 34381870 PMCID: PMC8333339 DOI: 10.1016/j.ijcha.2021.100848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 12/04/2022]
Abstract
Background Percutaneous LAAO represents an alternative for stroke prevention in patients not tolerating anticoagulation. While women are at higher risk of complications during percutaneous coronary or valvular interventions, the impact of gender on LAAO outcomes is not well characterized. The current study assessed potential gender-related differences in procedural and long-term outcomes following left atrial appendage occlusion (LAAO). Methods 1088 AF patients were enrolled in the prospective, multicenter, Amplatzer™ Amulet™ Observational Study and followed for 2 years with scheduled adverse event assessments. The prespecified primary outcome was ischemic stroke, systemic embolism or cardiovascular (CV) death at 2 years. We also compared the rate of procedural success, device-related thrombus (DRT) and major bleeding between genders. Results 702 men and 386 women underwent LAAO. Implant successwas high, and similar between men and women (98.9 vs 99.5%, p = 0.58). Similarly, no difference was observed in the primary outcome (12.0 vs 12.5%, p = 0.82). Compared to the CHA2DS2-VASc predicted rate, we observed a numerically greater absolute risk reduction of ischemic stroke in women (from 7.6 to 2.1%/year) than men (from 6.2 to 2.2%/year). DRT through 2 years was similar between groups (1.6%, p = 0.96). We found no significant gender difference in terms of periprocedural or long-term (7.1 vs 7.6%/year) major bleeding. Conclusions In this large group of patients undergoing LAAO using the Amplatzer™ Amulet™ device we found no significant gender difference in terms of procedural or long-term clinical outcomes. Similarly to oral anticoagulation, device-based LAA occlusion renders AF-related stroke risk similar in women and men. Clinical trial registration Clinicaltrials.gov Identifier: NCT02447081. https://clinicaltrials.gov/ct2/show/NCT02447081.
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Key Words
- AF, atrial fibrillation
- CV, cardiovascular
- DAPT, dual antiplatelet therapy
- DRT, device-related thrombus
- Gender difference
- LAAO, left atrial appendage occlusion
- Left atrial appendage occlusion
- Mortality
- PCI, percutaneous coronary intervention
- SAPT, single antiplatelet therapy
- Stroke
- TAVI, transcatheter aortic valve implantation
- TEE, transesophageal echocardiography
- TIA, transient ischemic attack
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12
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Ullah W, Zahid S, Zaidi SR, Sarvepalli D, Haq S, Roomi S, Mukhtar M, Khan MA, Gowda SN, Ruggiero N, Vishnevsky A, Fischman DL. Predictors of Permanent Pacemaker Implantation in Patients Undergoing Transcatheter Aortic Valve Replacement - A Systematic Review and Meta-Analysis. J Am Heart Assoc 2021; 10:e020906. [PMID: 34259045 PMCID: PMC8483489 DOI: 10.1161/jaha.121.020906] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background As transcatheter aortic valve replacement (TAVR) technology expands to healthy and lower‐risk populations, the burden and predictors of procedure‐related complications including the need for permanent pacemaker (PPM) implantation needs to be identified. Methods and Results Digital databases were systematically searched to identify studies reporting the incidence of PPM implantation after TAVR. A random‐ and fixed‐effects model was used to calculate unadjusted odds ratios (OR) for all predictors. A total of 78 studies, recruiting 31 261 patients were included in the final analysis. Overall, 6212 patients required a PPM, with a mean of 18.9% PPM per study and net rate ranging from 0.16% to 51%. The pooled estimates on a random‐effects model indicated significantly higher odds of post‐TAVR PPM implantation for men (OR, 1.16; 95% CI, 1.04–1.28); for patients with baseline mobitz type‐1 second‐degree atrioventricular block (OR, 3.13; 95% CI, 1.64–5.93), left anterior hemiblock (OR, 1.43; 95% CI, 1.09–1.86), bifascicular block (OR, 2.59; 95% CI, 1.52–4.42), right bundle‐branch block (OR, 2.48; 95% CI, 2.17–2.83), and for periprocedural atriorventricular block (OR, 4.17; 95% CI, 2.69–6.46). The mechanically expandable valves had 1.44 (95% CI, 1.18–1.76), while self‐expandable valves had 1.93 (95% CI, 1.42–2.63) fold higher odds of PPM requirement compared with self‐expandable and balloon‐expandable valves, respectively. Conclusions Male sex, baseline atrioventricular conduction delays, intraprocedural atrioventricular block, and use of mechanically expandable and self‐expanding prosthesis served as positive predictors of PPM implantation in patients undergoing TAVR.
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Affiliation(s)
- Waqas Ullah
- Thomas Jefferson University Hospitals Philadelphia PA
| | | | | | | | | | | | - Maryam Mukhtar
- University Hospitals of Leicester NHS Trust Leicester UK
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13
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Chiam PTL, Hayashida K, Watanabe Y, Yin WH, Kao HL, Lee MKY, Posas FE, Chandavimol M, Buddhari W, Dy TC, Nguyen NQ, Kim WJ, Chang K, Lin MS, Lam YY, Pham HM, Yahaya SA, Ho KW, Pan W, Liu XB, Wang J, Kim HS, Chen M. Sex differences in patients undergoing transcatheter aortic valve replacement in Asia. Open Heart 2021; 8:openhrt-2020-001541. [PMID: 33419935 PMCID: PMC7798412 DOI: 10.1136/openhrt-2020-001541] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/12/2020] [Accepted: 12/14/2020] [Indexed: 02/05/2023] Open
Abstract
Objectives Transcatheter aortic valve replacement (TAVR) is increasingly performed. Physically small Asians have smaller aortic root and peripheral vessel anatomy. The influence of gender of Asian patients undergoing TAVR is unknown and may affect outcomes. The aim of this study was to assess sex differences in Asian patients undergoing TAVR. Methods Patients undergoing TAVR from eight countries were enrolled. In this retrospective analysis, we examined differences in characteristics, 30-day clinical outcomes and 1-year survival between female and male Asian patients. Results Eight hundred and seventy-three patients (54.4% women) were included. Women were older, smaller and had less coronary artery and lung disease but tended to have higher logistic EuroSCOREs. Smaller prostheses were used more often in women. Major vascular complications occurred more frequently in women (5.5% vs 1.8%, p<0.01); however, 30-day stroke and mortality (women vs men: 1.5% vs 1.6%, p=0.95% and 4.3% vs 3.4%, p=0.48) were similar. Functional status improvement was significant and comparable between the sexes. Conduction disturbance and permanent pacemaker requirements (11.2% vs 9.0%, p=0.52) were also similar as was 1-year survival (women vs men: 85.6% vs 88.2%, p=0.25). The only predictors of 30-day mortality were major vascular injury in women and age in men. Conclusions Asian women had significantly smaller stature and anatomy with some differences in clinical profiles. Despite more frequent major vascular complications, women had similar 30-day stroke or mortality rates. Functional status improvement was significant and comparable between the sexes. Conduction disturbance and permanent pacemaker requirements were similar as was 1-year survival.
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Affiliation(s)
- Paul T L Chiam
- The Heart and Vascular Centre, Mount Elizabeth Medical Centre, Singapore
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Yusuke Watanabe
- Department of Cardiology, Teikyo University Hospital, Tokyo, Japan
| | - Wei-Hsian Yin
- Division of Cardiology, Heart Center, Cheng-Hsin General Hospital, Taipei, Taiwan
| | - Hsien-Li Kao
- Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Michael K Y Lee
- Department of Cardiology, Queen Elizabeth Hospital, Hong Kong, Hong Kong
| | | | | | | | - Timothy C Dy
- Heart Institute, Chinese General Hospital and Medical Centre, Manila, Philippines
| | - Ngoc Quang Nguyen
- Department of Cardiology, Vietnam National Heart Institute, Hanoi, Vietnam
| | - Won Jang Kim
- Department of Cardiology, CHA Bundang Medical Centre, Seoul, Republic of Korea
| | - Kiyuk Chang
- Cardiology, The Catholic University of Korea Seoul St. Mary's Hospital, Seoul, Republic of Korea
| | - Mao-Shin Lin
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yat-Yin Lam
- Hong Kong Asia Heart Centre, Canossa Hospital, Hong Kong, Hong Kong
| | - Hung Manh Pham
- Department of Cardiology, Vietnam National Heart Institute, Hanoi, Vietnam
| | | | - Kay Woon Ho
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Wenzhi Pan
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xian-Bao Liu
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jian'an Wang
- Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hyo Soo Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Mao Chen
- Department of Cardiology, Sichuan University West China Hospital, Chengdu, China
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14
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Chikata Y, Iwata H, Doi S, Funamizu T, Okazaki S, Dohi S, Higuchi R, Saji M, Takamisawa I, Tamura H, Amano A, Daida H, Minamino T. Simultaneous Estimation of Gender Male and Atrial Fibrillation as Risk Factors for Adverse Outcomes Following Transcatheter Aortic Valve Implantation. J Clin Med 2020; 9:E3963. [PMID: 33297434 PMCID: PMC7762231 DOI: 10.3390/jcm9123963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 11/28/2020] [Accepted: 12/04/2020] [Indexed: 01/09/2023] Open
Abstract
Accurate outcome prediction following transcatheter aortic valve implantation (TAVI) has gained further importance along with expanding its indication to patients with a lower surgical risk. Although previous studies have evaluated the prognostic impacts of gender and atrial fibrillation (AF) in TAVI patients, these two factors have rarely been addressed simultaneously. This retrospective observational study based on a multicenter TAVI registry involved 1088 patients who underwent TAVI between May, 2010 and February, 2020 at 3 hospitals in Japan. Participants were divided into 4 groups by gender and pre-existing AF, such as Female AF(-) (n = 559), Male AF(-) (n = 266), Female AF(+) (n = 187) and Male AF(+) (n = 76). Primary and secondary endpoints were death due to any and cardiovascular cause, and the composite of all-cause death and heart failure hospitalization, respectively. The median follow-up period was 538 days. Cumulative incidences of primary and secondary endpoints were lower in the Female AF(-) group compared to the other 3 groups. Adjusted multivariate Cox proportional hazard analyses showed an independent association of either or both of male gender and AF with adverse outcomes, when compared to the group with none of these (hazard ratios and 95% confidence intervals vs. Female AF(-) (reference) for all-cause death of Male AF(-): 2.7, 1.6-4.6, p < 0.001, Female AF(+): 3.5, 2.1-6.0, p < 0.001, and Male AF(+): 3.9, 1.9-7.8, p < 0.001), while there was no evidence of their synergistic prognostic impact. Male gender and being complicated by AF independently, but not synergistically, predicted poor long-term outcomes in patients undergoing TAVI.
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Affiliation(s)
- Yuichi Chikata
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; (Y.C.); (S.D.); (T.F.); (S.O.); (H.D.); (T.M.)
| | - Hiroshi Iwata
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; (Y.C.); (S.D.); (T.F.); (S.O.); (H.D.); (T.M.)
| | - Shinichiro Doi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; (Y.C.); (S.D.); (T.F.); (S.O.); (H.D.); (T.M.)
| | - Takehiro Funamizu
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; (Y.C.); (S.D.); (T.F.); (S.O.); (H.D.); (T.M.)
| | - Shinya Okazaki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; (Y.C.); (S.D.); (T.F.); (S.O.); (H.D.); (T.M.)
| | - Shizuyuki Dohi
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; (S.D.); (A.A.)
| | - Ryosuke Higuchi
- Department of Cardiology, Sakakibara Heart Institute, Tokyo 183-0003, Japan; (R.H.); (M.S.); (I.T.)
| | - Mike Saji
- Department of Cardiology, Sakakibara Heart Institute, Tokyo 183-0003, Japan; (R.H.); (M.S.); (I.T.)
| | - Itaru Takamisawa
- Department of Cardiology, Sakakibara Heart Institute, Tokyo 183-0003, Japan; (R.H.); (M.S.); (I.T.)
| | - Harutoshi Tamura
- Department of Cardiology, Pulmonology and Nephrology, Yamagata University School of Medicine, Yamagata 990-9585, Japan;
| | - Atsushi Amano
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; (S.D.); (A.A.)
| | - Hiroyuki Daida
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; (Y.C.); (S.D.); (T.F.); (S.O.); (H.D.); (T.M.)
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; (Y.C.); (S.D.); (T.F.); (S.O.); (H.D.); (T.M.)
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15
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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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16
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Chang HH, Chen PL, Leu HB, Chen IM, Wu NY, Chen YH. Sex difference in the prognostic role of body composition parameters in Taiwanese patients undergoing transcatheter aortic valve implantation. BMC Cardiovasc Disord 2020; 20:283. [PMID: 32522169 PMCID: PMC7288684 DOI: 10.1186/s12872-020-01569-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 06/03/2020] [Indexed: 02/02/2023] Open
Abstract
Background Evidence on association between body composition and outcomes of transcatheter aortic valve implantation (TAVI) is limited for Asian patients. This study investigated the prognostic role of body composition parameters in Taiwanese patients undergoing TAVI. Materials and methods Data of consecutive patients undergoing TAVI for severe aortic stenosis between May 1, 2010 and August 31, 2019 were prospectively collected in this observational study. The association between body composition parameters (body mass index [BMI], body surface area [BSA], lean body mass [LBM], and LBM index) and cumulative mortality was analyzed using Cox proportional hazard regression model. Results A total of 221 patients (mean age 81.4 years), including 125 (56.6%) males, were included with median follow-up duration of 23.8 months. In males, multivariate analysis revealed that higher BMI (P = 0.035), BMI ≥ 20 kg/m2 (P = 0.026), and higher LBM index (P = 0.023) significantly predicted lower overall all-cause cumulative mortality. In females, none of the body composition parameters was significantly associated with all-cause cumulative mortality. Paradoxical association between BMI and estimated all-cause cumulative mortality was only significant among male patients. Conclusion In Taiwanese TAVI patients, the prognostic effects of BMI and LBM index on cumulative mortality were only observed in males, not in females. Sex differences must be considered when stratifying risk among patients undergoing TAVI.
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Affiliation(s)
- Hsiao-Huang Chang
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Surgery, School of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Biomedical Sciences and Engineering, National Central University, Taoyuan, Taiwan
| | - Po-Lin Chen
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hsin-Bang Leu
- Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei, 11217, Taiwan
| | - I-Ming Chen
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Nai-Yuan Wu
- Institute of Biomedical Informatics, National Yang-Ming University, Taipei, Taiwan
| | - Ying-Hwa Chen
- Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan. .,Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei, 11217, Taiwan.
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Bignoto TC, Bihan D, Barretto RB, Ramos AI, Moreira DAR, Simonato M, Siqueira DA, Pinto IMF, Santos TSG, Sousa AG, Abizaid A. Predictive role of Selvester
QRS
score in patients undergoing transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2020; 97:E95-E103. [DOI: 10.1002/ccd.28905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 03/28/2020] [Accepted: 03/31/2020] [Indexed: 01/01/2023]
Affiliation(s)
| | - David Bihan
- Dante Pazzanese Institute of Cardiology São Paulo São Paulo Brazil
| | | | | | | | - Matheus Simonato
- Dante Pazzanese Institute of Cardiology São Paulo São Paulo Brazil
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Long-Term Follow-Up of Transcatheter Aortic Valve Implantation With Portico Versus Evolut Devices. Am J Cardiol 2020; 125:1209-1215. [PMID: 32087996 DOI: 10.1016/j.amjcard.2020.01.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 01/07/2020] [Accepted: 01/13/2020] [Indexed: 02/08/2023]
Abstract
New-generation devices such as Evolut and Portico have provided favorable results in patients who underwent transcatheter aortic valve implantation (TAVI) for aortic stenosis, but their comparative effectiveness remains debated, despite its relevance when envisioning TAVI in low-risk patients. We evaluated the safety and efficacy of 2 leading TAVI devices (Evolut and Portico) used by the same team of experienced TAVI operators, focusing on long-term outcomes, including major adverse events (i.e., the composite of death, stroke, myocardial infarction, major vascular complication, or major bleeding). Unadjusted and propensity score-adjusted analyses were carried out. A total of 233 patients were included, 119 (51.1%) receiving Evolut and 114 (49%) Portico. Baseline and procedural data showed significant between-device differences, including functional class, surgical risk, chronic obstructive pulmonary disease, renal function, transesophageal guidance, device size, postdilation, and procedural time (all p <0.05). Yet, acute and in-hospital outcomes were not significantly different (all p >0.05). Follow-up status was ascertained in 228 (98%) patients after 15.0 ± 7.6 months. Unadjusted analysis showed similar rates of major adverse events, as well as the individual risk of death, stroke, myocardial infarction, major vascular complication, major bleeding, and pacemaker implantation (all p >0.05). Even at propensity score-adjusted analysis outcomes were not significantly different with Evolut and Portico (all p >0.05). In conclusion, Evolut and Portico devices yield similarly favorable results at long-term follow-up when used by experienced TAVI operators.
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Klaeboe LG, Brekke PH, Aaberge L, Haugaa K, Edvardsen T. Impact of transcatheter aortic valve implantation on mechanical dispersion. Open Heart 2020; 7:e001199. [PMID: 32153792 PMCID: PMC7046982 DOI: 10.1136/openhrt-2019-001199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 01/21/2020] [Accepted: 02/06/2020] [Indexed: 11/04/2022] Open
Abstract
Objectives The physiological determinants of left ventricular (LV) mechanical dispersion (MD) are not fully explored. We aimed to investigate the impact of afterload reduction and changes in ventricular conduction on LV MD after transcatheter aortic valve implantation (TAVI). Methods Patients with severe aortic stenosis (AS) were examined in a prospective, repeated measures observational cohort study before and after an uncomplicated transfemoral TAVI in a single tertiary centre. LV MD was assessed by speckle tracking echocardiography. Valvulo-arterial impedance (ZVA) was used as a measure of global afterload. Results We included 140 consecutive patients (83±8 years old, 49% women, logistic EuroSCORE 16±10) with severe AS (valve area 0.7±0.2 cm2, mean transvalvular gradient 54±18 mm Hg) and a relatively preserved LV ejection fraction (52%±11%). After TAVI, we observed favourable changes in transvalvular gradients and ZVA in all patients. Compared with baseline, postprocedural MD was significantly lower in 108 patients with unchanged ventricular conduction (55±17 ms vs 51±17 ms, p=0.02) and higher in 28 patients with TAVI-induced left bundle branch block (51±13 ms vs 62±19 ms, p≤0.001). During 22±9 months observation, 22 patients died. Postprocedural MD was associated with mortality in a univariate Cox regression model (HR=1.24 (1.01-1.52), p<0.04, per 10 ms increase). Conclusions Isolated afterload reduction was associated with reduction of MD, while concomitant impairment of ventricular conduction resulted in a more pronounced MD after TAVI, indicating that loading conditions and conduction should be considered when evaluating MD. A pronounced postprocedural LV MD was associated with mortality.
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Affiliation(s)
- Lars Gunnar Klaeboe
- Department of Cardiology and Center for Cardiological Innovation, Oslo University Hospital Rikshospitalet, Oslo, Norway.,K.G. Jebsen Center for Cardiac Research, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Pål Haugar Brekke
- Department of Cardiology and Center for Cardiological Innovation, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Lars Aaberge
- Department of Cardiology and Center for Cardiological Innovation, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Kristina Haugaa
- Department of Cardiology and Center for Cardiological Innovation, Oslo University Hospital Rikshospitalet, Oslo, Norway.,K.G. Jebsen Center for Cardiac Research, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Thor Edvardsen
- Department of Cardiology and Center for Cardiological Innovation, Oslo University Hospital Rikshospitalet, Oslo, Norway.,K.G. Jebsen Center for Cardiac Research, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Conrotto F, D'Ascenzo F, Bianco M, Salizzoni S, D'Onofrio A, Ribichini F, Tarantini G, D'Amico M, Moretti C, Rinaldi M. Is oral anticoagulation effective in preventing transcatheter aortic valve implantation failure? A propensity matched analysis of the Italian Transcatheter balloon-Expandable valve Registry study. J Cardiovasc Med (Hagerstown) 2019; 21:51-57. [PMID: 31869314 DOI: 10.2459/jcm.0000000000000880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Early hypo-attenuated leaflet thickening after transcatheter aortic valve implantation (TAVI) has been recently described presumably reflecting thrombus apposition. Although its clinical relevance is still unknown, oral anticoagulant therapy (OAT) led to almost complete resolution. METHODS The retrospecitve Italian Transcatheter balloon-Expandable valve registry that included all patients undergoing balloon-expandable TAVI in 33 Italian centers. Patients discharged after TAVI with aspirin alone were compared with those assuming aspirin and OAT before and after propensity score with matching. Prosthetic heart valve dysfunction at follow-up was the primary end point. All-cause death, cardiovascular death, bleeding, vascular complications and cerebrovascular accidents at 30 days and at follow-up were the secondary ones. RESULTS Among the 1904 patients enrolled in the Italian Transcatheter balloon-Expandable valve registry, 716 patients on OAT and aspirin or aspirin alone were identified and analyzed: 555 were on aspirin alone and 161 on OAT and aspirin. The median follow-up was 44.0 ± 12 months. After matching, risk of prosthetic valve dysfunction at follow-up did not differ between the two groups: 3.1% in patients treated with aspirin alone vs. 1.9% in those treated with OAT and aspirin, (P = 0.72). Nevertheless patients treated with aspirin alone at follow-up had a significantly lower risk of death (21 vs. 33%, P = 0.03) and major bleeding (4 vs. 14%, P = 0.04) with a similar rate of stroke/transient ischemic attack (TIA) (1.2 vs. 3.1%, P = 0.45). At 30 days rates of Valve Academic Research Consortium death were similar in both groups (0.6 vs. 3.7%, P = 0.12) with higher risk of life threatening bleeding and minor vascular complications in patients on OAT and aspirin. CONCLUSION After TAVI with Edwards Sapien valve OAT did not reduce the incidence of valve dysfunction and stroke but was responsible for mortality and bleeding increases.
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Affiliation(s)
- Federico Conrotto
- Divisione di Cardiologia, Dipartimento di Scienze Mediche, Città della Salute e della Scienza
| | - Fabrizio D'Ascenzo
- Divisione di Cardiologia, Dipartimento di Scienze Mediche, Città della Salute e della Scienza
| | - Matteo Bianco
- Division of Cardiology, A.O.U. San Luigi Gonzaga, Turin
| | - Stefano Salizzoni
- Divisione di Cardiologia, Dipartimento di Scienze Mediche, Città della Salute e della Scienza
| | | | - Flavio Ribichini
- Division of Cardiology, Department of Medicine, University of Verona, Verona
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Maurizio D'Amico
- Divisione di Cardiologia, Dipartimento di Scienze Mediche, Città della Salute e della Scienza
| | - Claudio Moretti
- Divisione di Cardiologia, Dipartimento di Scienze Mediche, Città della Salute e della Scienza
| | - Mauro Rinaldi
- Divisione di Cardiologia, Dipartimento di Scienze Mediche, Città della Salute e della Scienza
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21
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Wang TY, Gracia E, Callahan S, Bilfinger T, Tannous H, Pyo R, Kort S, Skopicki H, Weinstein J, Patel N, Montellese D, Korlipara G, Khan S, Chikwe J, Parikh PB. Gender Disparities in Management and Outcomes Following Transcatheter Aortic Valve Implantation With Newer Generation Transcatheter Valves. Am J Cardiol 2019; 123:1489-1493. [PMID: 30782416 DOI: 10.1016/j.amjcard.2019.01.048] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 01/19/2019] [Accepted: 01/22/2019] [Indexed: 01/09/2023]
Abstract
The impact of gender on management and early outcomes after transcatheter aortic valve implantation (TAVI) in the setting of newer generation transcatheter heart valves (THVs) is not well known. We evaluated gender-specific differences on clinical management and in-hospital outcomes in adults who underwent TAVI with newer generation THVs. The study population included 298 consecutive patients who underwent TAVI and received a newer generation THV (Sapien 3 [Edwards Lifesciences, Irvine, California] or Corevalve Evolut R or Evolut Pro [Medtronic, Minneapolis, Minnesota]) from December 2015 to June 2018 at an academic tertiary medical center. Of the 298 patients, 154 (52%) were men and 144 (48%) were women. Compared with men, women were older, had lower serum creatinine, higher left ventricular ejection fraction, and lower rates of multiple co-morbidities, including previous coronary artery bypass graft surgery, previous myocardial infarction, and atrial fibrillation. Women were noted to have smaller aortic annular area and perimeter and underwent implantation of smaller THVs than men. At the time of discharge, women were more frequently prescribed a P2Y12 inhibitor (primarily clopidogrel) and less frequently prescribed oral anticoagulation (namely warfarin). Hospital length of stay and in-hospital rates of mortality, disabling stroke, and pacemaker were similar in men and women. In conclusion, in this observational prospective study of adults who underwent TAVI with newer generation THVs, while gender-related disparities in clinical presentation and procedural management were observed, no significant difference in clinical outcomes were noted in men and women. Further studies examining gender-related differences in procedural and postprocedural care after TAVI in the contemporary era are warranted to better understand and optimize clinical outcomes in both men and women.
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Affiliation(s)
- Ting-Yu Wang
- Division of Cardiovascular Medicine, Department of Medicine, State University of New York at Stony Brook, Stony Brook, New York
| | - Ely Gracia
- Division of Cardiovascular Medicine, Department of Medicine, State University of New York at Stony Brook, Stony Brook, New York
| | - Susan Callahan
- Division of Cardiothoracic Surgery, Department of Medicine, State University of New York at Stony Brook, Stony Brook, New York
| | - Thomas Bilfinger
- Division of Cardiothoracic Surgery, Department of Medicine, State University of New York at Stony Brook, Stony Brook, New York
| | - Henry Tannous
- Division of Cardiothoracic Surgery, Department of Medicine, State University of New York at Stony Brook, Stony Brook, New York
| | - Robert Pyo
- Division of Cardiovascular Medicine, Department of Medicine, State University of New York at Stony Brook, Stony Brook, New York
| | - Smadar Kort
- Division of Cardiovascular Medicine, Department of Medicine, State University of New York at Stony Brook, Stony Brook, New York
| | - Hal Skopicki
- Division of Cardiovascular Medicine, Department of Medicine, State University of New York at Stony Brook, Stony Brook, New York
| | - Jonathan Weinstein
- Division of Cardiovascular Medicine, Department of Medicine, State University of New York at Stony Brook, Stony Brook, New York
| | - Neal Patel
- Division of Cardiovascular Medicine, Department of Medicine, State University of New York at Stony Brook, Stony Brook, New York
| | - Daniel Montellese
- Division of Cardiovascular Medicine, Department of Medicine, State University of New York at Stony Brook, Stony Brook, New York
| | - Giridhar Korlipara
- Division of Cardiovascular Medicine, Department of Medicine, State University of New York at Stony Brook, Stony Brook, New York
| | - Shamim Khan
- Division of Cardiovascular Medicine, Department of Medicine, State University of New York at Stony Brook, Stony Brook, New York
| | - Joanna Chikwe
- Division of Cardiothoracic Surgery, Department of Medicine, State University of New York at Stony Brook, Stony Brook, New York
| | - Puja B Parikh
- Division of Cardiovascular Medicine, Department of Medicine, State University of New York at Stony Brook, Stony Brook, New York.
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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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23
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Impact of gender on outcomes after transcatheter aortic valve implantation. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2018; 15:394-400. [PMID: 30108610 PMCID: PMC6087513 DOI: 10.11909/j.issn.1671-5411.2018.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Backgound The influence of gender on clinical outcomes following transcatheter aortic valve implantation (TAVI) was considerably discrepant in previous studies. We aimed to investigate the impact of gender in our registry. Methods The study is a retrospective observational analysis of a prospectively designed cohort (546 consecutive patients treated at the University Hospital Zurich who were enrolled in Swiss TAVI Cohort from May 2008 to April 2014). The Study took place in University Heart Centre at University Hospital Zurich, Switzerland. Results Both genders were equally represented with 51.5 % (n = 281) of the populations being females, who were significantly older and had a more pronounced history of hypertension (P < 0.001). Males on the other hand showed a higher incidence of diabetes (P = 0.004), coronary artery disease (P < 0.001), chronic obstructive pulmonary disease (P < 0.001) and renal failure requiring renal replacement therapy (P = 0.018). Patients were followed up for a median of 391 days with a 100% complete follow-up at one year. The primary outcome (all-cause mortality) occurred in 6.8% (n = 37) and 15% (n = 82) of patients at 30 days and one year, respectively. The 30-day all-cause mortality outcome did not significantly differ between females (7.5%) and males (6.0%) (P = 0.619), but one year all-cause mortality occurred significantly more in males than in females (18.7% vs. 11.7%, P < 0.037). Conclusion After TAVI implantation for severe aortic stenosis, males have a less favorable long-term (one year) mortality outcome than females.
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24
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Kaier K, von zur Mühlen C, Zirlik A, Schmoor C, Roth K, Bothe W, Hehn P, Reinöhl J, Zehender M, Bode C, Stachon P. Sex-Specific Differences in Outcome of Transcatheter or Surgical Aortic Valve Replacement. Can J Cardiol 2018; 34:992-998. [DOI: 10.1016/j.cjca.2018.04.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 03/26/2018] [Accepted: 04/02/2018] [Indexed: 01/09/2023] Open
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25
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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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Mihos CG, Klassen SL, Yucel E. Sex-Specific Considerations in Women with Aortic Stenosis and Outcomes After Transcatheter Aortic Valve Replacement. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:52. [PMID: 29923126 DOI: 10.1007/s11936-018-0651-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Aortic stenosis (AS) is the most common valvular disease in the elderly and is associated with poor outcomes. Transcatheter aortic valve replacement (TAVR) is an alternative to surgical aortic valve replacement (SAVR) in high-risk patients. Herein, we describe the gender-related differences in baseline characteristics and pathophysiologic response to severe AS, imaging considerations unique to females, and short- and long-term outcomes after TAVR. Women undergoing TAVR are older and frailer, have less cardiovascular comorbidities, smaller femoral artery size, better left ventricular systolic function, hypertrophied and small left ventricles leading to a higher incidence of paradoxical low-flow low-gradient AS, and a greater prevalence of porcelain aorta, smaller aortic annulus size, and lower coronary ostia heights. Imaging and histopathological data also suggests a sex-related myocardial response to pressure overload from AS. Women experience more vascular complications and blood transfusion requirements, serious procedural complications, and a greater incidence of stroke, but have better long-term outcomes than men. Patient-prosthesis mismatch, which is a concern in patients with a small aortic annulus size undergoing SAVR, has not been problematic with TAVR. The aforementioned findings suggest that TAVR may be preferable for women with severe AS. Further studies are warranted to directly compare TAVR with SAVR in women.
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Affiliation(s)
- Christos G Mihos
- Echocardiography Laboratory, Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL, USA
| | - Sheila L Klassen
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Yawkey 5B, Boston, MA, 02114, USA
| | - Evin Yucel
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Yawkey 5B, Boston, MA, 02114, USA.
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27
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Saad M, Nairooz R, Pothineni NVK, Almomani A, Kovelamudi S, Sardar P, Katz M, Abdel-Wahab M, Bangalore S, Kleiman NS, Block PC, Abbott JD. Long-Term Outcomes With Transcatheter Aortic Valve Replacement in Women Compared With Men. JACC Cardiovasc Interv 2018; 11:24-35. [DOI: 10.1016/j.jcin.2017.08.015] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 07/24/2017] [Accepted: 08/02/2017] [Indexed: 11/25/2022]
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Doshi R, Shlofmitz E, Meraj P. Comparison of Outcomes and Complications of Transcatheter Aortic Valve Implantation in Women Versus Men (from the National Inpatient Sample). Am J Cardiol 2018; 121:73-77. [PMID: 29103601 DOI: 10.1016/j.amjcard.2017.09.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 09/11/2017] [Accepted: 09/14/2017] [Indexed: 01/09/2023]
Abstract
Transcatheter aortic valve implantation (TAVI) is a rapidly emerging procedure for the treatment of intermediate and high-surgical-risk patients with severe aortic stenosis. The impact of gender on in-hospital outcomes has not been studied on a large scale. The aim of this study was to examine gender differences in in-hospital outcomes after TAVI. The National Inpatient Sample (2012 to 2014) using the International Classification of Diseases, 9th Revision, Clinical Modification procedure codes for TAVI (35.05 and 35.06) were used to form this database. Propensity score matching (1:1) was performed and in-hospital outcomes were compared. The primary outcome was in-hospital mortality. Statistical analysis was performed using SAS 9.4 (SAS Institute Inc., Cary, North Carolina). A total of 41,050 (weighted) patients were included in our study. Women accounted for 47.7% (n = 19,570) in our study and presented with older age (81.7 years vs 80.5 years, p ≤ 0.0001). The population was predominantly white (87.4%). After performing propensity score-matched analysis (1:1), no difference in the primary outcome was noted between men and women. The secondary outcomes including stroke, hemorrhage requiring transfusion, and pericardial complications were higher in women. The composite end point of death and stroke occurred more frequently in women than in men. Acute renal failure was higher in men. The post-TAVI length of stay was higher in women (8.3 days vs 7.7 days, p = 0.0007). In conclusion, this large, retrospective registry analysis of patients with severe aortic stenosis who underwent TAVI suggests women may experience higher rates of in-hospital morbidity compared with men.
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Affiliation(s)
- Rajkumar Doshi
- Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, New York
| | - Evan Shlofmitz
- Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, New York
| | - Perwaiz Meraj
- Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, New York.
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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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Liu L, Xu B, Ju Y. Addition of spironolactone in patients with resistant hypertension: A meta-analysis of randomized controlled trials. Clin Exp Hypertens 2017; 39:257-263. [DOI: 10.1080/10641963.2016.1246564] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Czarnecki A, Qiu F, Koh M, Prasad TJ, Cantor WJ, Cheema AN, Chu MW, Feindel C, Fremes SE, Kingsbury K, Natarajan MK, Peterson MD, Ruel M, Strauss BH, Wijeysundera HC, Ko DT. Clinical outcomes after trans-catheter aortic valve replacement in men and women in Ontario, Canada. Catheter Cardiovasc Interv 2017; 90:486-494. [DOI: 10.1002/ccd.26906] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 12/05/2016] [Accepted: 12/12/2016] [Indexed: 01/09/2023]
Affiliation(s)
- Andrew Czarnecki
- Schulich Heart Centre; Division of Cardiology, Sunnybrook Health Sciences Centre, University of Toronto; Ontario Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto; Ontario Canada
- Institute for Clinical Evaluative Sciences (ICES); Toronto Ontario Canada
| | - Feng Qiu
- Institute for Clinical Evaluative Sciences (ICES); Toronto Ontario Canada
| | - Maria Koh
- Institute for Clinical Evaluative Sciences (ICES); Toronto Ontario Canada
| | - Treesa J. Prasad
- Institute for Clinical Evaluative Sciences (ICES); Toronto Ontario Canada
| | | | - Asim N. Cheema
- St Michael's Hospital, University of Toronto; Ontario Canada
| | - Michael W.A. Chu
- London Health Sciences Centre, University of Western Ontario; London Ontario Canada
| | | | - Stephen E. Fremes
- Schulich Heart Centre; Division of Cardiology, Sunnybrook Health Sciences Centre, University of Toronto; Ontario Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto; Ontario Canada
| | | | | | - Mark D. Peterson
- St Michael's Hospital, University of Toronto; Ontario Canada
- Li Ka Shing Knowledge Institute of St. Michael's Hospital; Toronto Ontario Canada
| | - Marc Ruel
- Ottawa Heart Institute; Ottawa Ontario Canada
| | - Bradley H. Strauss
- Schulich Heart Centre; Division of Cardiology, Sunnybrook Health Sciences Centre, University of Toronto; Ontario Canada
| | - Harindra C. Wijeysundera
- Schulich Heart Centre; Division of Cardiology, Sunnybrook Health Sciences Centre, University of Toronto; Ontario Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto; Ontario Canada
- Institute for Clinical Evaluative Sciences (ICES); Toronto Ontario Canada
| | - Dennis T. Ko
- Schulich Heart Centre; Division of Cardiology, Sunnybrook Health Sciences Centre, University of Toronto; Ontario Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto; Ontario Canada
- Institute for Clinical Evaluative Sciences (ICES); Toronto Ontario Canada
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Comparison in Men Versus Women of Co-morbidities, Complications, and Outcomes After Transcatheter Aortic Valve Implantation for Severe Aortic Stenosis. Am J Cardiol 2016; 118:1692-1697. [PMID: 27666174 DOI: 10.1016/j.amjcard.2016.08.049] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 08/18/2016] [Accepted: 08/18/2016] [Indexed: 01/09/2023]
Abstract
Transcatheter aortic valve implantation (TAVI) decreases mortality in high-risk patients with severe aortic stenosis, but it remains unclear if female gender is associated with more favorable outcomes after TAVI. All patients who underwent TAVI at a single institution were retrospectively analyzed and stratified by gender. Procedural, in-hospital, 30-day, and 1-year outcomes were defined according to the second Valve Academic Research Consortium. The primary end point was all-cause mortality at 1 year. Kaplan-Meier survival analysis and multivariable Cox proportional hazards regression were conducted. Overall, 755 patients underwent TAVI and were included in the study; 50.7% were women. Average age was 83.0 ± 7.7 years, with a mean Society of Thoracic Surgeons score of 8.9 ± 4.6. Women were older than men and more likely to be black. Most co-morbidities were less common among women, and they were more likely than men to suffer both in-hospital (8.4% vs 4.3%, p = 0.021) and 30-day (9.4% vs 5.4%, p = 0.035) all-cause mortality. Life-threatening bleeding, transfusion, and iliofemoral dissection or perforation were more common among women. There was no difference in mortality between women and men at 1 year (20.6% vs 21.5%, log-rank p = 0.87). After multivariable adjustment, however, female gender was independently associated with lower mortality at 1 year after TAVI. In conclusion, despite higher rates of major bleeding, vascular complications, and 30-day mortality, female gender was independently associated with improved survival at 1 year after TAVI.
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Katz M, Carlos Bacelar Nunes Filho A, Caixeta A, Antonio Carvalho L, Sarmento-Leite R, Alves Lemos Neto P, Eduardo Koenig São Thiago L, Dias Dourado Oliveira A, Antonio Marino M, Tadeu Tumelero R, Antonio Perin M, Abizaid A, Tarasoutchi F, Sândoli de Brito F. Gender-related differences on short- and long-term outcomes of patients undergoing transcatheter aortic valve implantation. Catheter Cardiovasc Interv 2016; 89:429-436. [DOI: 10.1002/ccd.26658] [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: 01/27/2016] [Accepted: 06/14/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Marcelo Katz
- Hospital Israelita Albert Einstein; São Paulo SP Brazil
| | | | | | | | - Rogério Sarmento-Leite
- Instituto de Cardiologia do Rio Grande do Sul/Universidade Federal de Ciências da Saúde de Porto Alegre; Porto Alegre RS Brazil
| | | | | | | | | | | | | | - Alexandre Abizaid
- Hospital Israelita Albert Einstein; São Paulo SP Brazil
- Instituto Dante Pazzanese de Cardiologia; São Paulo SP Brazil
| | - Flavio Tarasoutchi
- Hospital Israelita Albert Einstein; São Paulo SP Brazil
- Heart Institute (InCor), University of Sao Paulo Medical School; São Paulo SP Brazil
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Gilard M, Schlüter M, Snow TM, Dall’Ara G, Eltchaninoff H, Moat N, Goicolea J, Ussia GP, Kala P, Wenaweser P, Zembala M, Nickenig G, Price S, Alegria Barrero E, Iung B, Zamorano P, Schuler G, Corti R, Alfieri O, Prendergast B, Ludman P, Windecker S, Sabate M, Witkowski A, Danenberg H, Schroeder E, Romeo F, Macaya C, Derumeaux G, Laroche C, Pighi M, Serdoz R, Di Mario C. The 2011-2012 pilot European Society of Cardiology Sentinel Registry of Transcatheter Aortic Valve Implantation: 12-month clinical outcomes. EUROINTERVENTION 2016; 12:79-87. [DOI: 10.4244/eijv12i1a15] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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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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Barbanti M, Gulino S, Tamburino C, Capodanno D. Antithrombotic therapy following transcatheter aortic valve implantation: what challenge do we face? Expert Rev Cardiovasc Ther 2016; 14:381-9. [PMID: 26601574 DOI: 10.1586/14779072.2016.1124760] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The issue of stroke and bleeding events following transcatheter aortic valve implantation (TAVI) and its relation with antithrombotic regimens before, during and after the procedure is increasingly recognized as an important issue. While dedicated trials are ongoing, there is no clear evidence at present on the best antithrombotic regimen in the context of TAVI. In this article, we will go through the mechanisms involved in embolic and bleeding complications of TAVI, and we will discuss the key aspects of antithrombotic treatment in patients undergoing TAVI.
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Affiliation(s)
- Marco Barbanti
- a Division of Cardiology-Ferrarotto Hospital , University of Catania , Catania , Italy
| | - Simona Gulino
- a Division of Cardiology-Ferrarotto Hospital , University of Catania , Catania , Italy
| | - Corrado Tamburino
- a Division of Cardiology-Ferrarotto Hospital , University of Catania , Catania , Italy.,b ETNA Foundation , Catania , Italy
| | - Davide Capodanno
- a Division of Cardiology-Ferrarotto Hospital , University of Catania , Catania , Italy
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Hahn RT. Sex-related differences in transcatheter aortic valve replacement outcomes: what do interventionalists need to know? Interv Cardiol 2015. [DOI: 10.2217/ica.15.45] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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O’Connor SA, Morice MC, Gilard M, Leon MB, Webb JG, Dvir D, Rodés-Cabau J, Tamburino C, Capodanno D, D’Ascenzo F, Garot P, Chevalier B, Mikhail GW, Ludman PF. Revisiting Sex Equality With Transcatheter Aortic Valve Replacement Outcomes. J Am Coll Cardiol 2015; 66:221-228. [DOI: 10.1016/j.jacc.2015.05.024] [Citation(s) in RCA: 156] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 03/27/2015] [Accepted: 05/07/2015] [Indexed: 01/09/2023]
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Moretti C, D'Ascenzo F, Mennuni M, Taha S, Brambilla N, Nijhoff F, Fraccaro C, Barbanti M, Tamburino C, Tarantini G, Rossi ML, Presbitero P, Napodanno M, Stella P, Bedogni F, Omedè P, Conrotto F, Montefusco A, Giordana F, Biondi Zoccai G, Agostoni P, D'Amico M, Rinaldi M, Marra S, Gaita F. Meta-analysis of comparison between self-expandable and balloon-expandable valves for patients having transcatheter aortic valve implantation. Am J Cardiol 2015; 115:1720-5. [PMID: 25890630 DOI: 10.1016/j.amjcard.2015.03.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 03/01/2015] [Accepted: 03/01/2015] [Indexed: 02/08/2023]
Abstract
Two different devices, 1 self-expanding and 1 balloon-expandable, have been developed for patients who underwent transcatheter aortic valve implantation with contrasting data about efficacy and safety. Pubmed, Medline, and Google Scholar were systematically searched for studies of these different devices, with data derived from randomized controlled trial or registries with multivariate analysis. All-cause death at 30 days and at follow-up were the primary end points, whereas postprocedural moderate or severe aortic regurgitation (AR), stroke, major vascular complications, bleedings, and pacemaker implantation the secondary ones. Six studies with 957 self-expanding and 947 balloon-expandable valves were included: 1 randomized controlled trial and 5 observational studies. At 30 days follow-up, rates of death did not differ between self-expanding and balloon-expandable valves (odds ratio [OR] 0.74, 95% confidence interval [CI] 0.47 to 1.17), whereas balloon expandable reduced rates of moderate or severe AR (OR 0.51, 95% CI 0.27 to 0.99) and of pacemaker implantation (OR 0.28, 95% CI 0.17 to 0.47). After a follow-up of 360 days (300 to 390), rates of all-cause death did not differ between the 2 groups. In conclusion, risks of moderate or severe AR and pacemaker implantation were lower with the balloon-expandable devices without an impact on 30 days and midterm mortality.
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Dobson LE, Fairbairn TA, Plein S, Greenwood JP. Sex Differences in Aortic Stenosis and Outcome Following Surgical and Transcatheter Aortic Valve Replacement. J Womens Health (Larchmt) 2015; 24:986-95. [PMID: 26653869 DOI: 10.1089/jwh.2014.5158] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Aortic stenosis is the commonest valve defect in the developed world and is associated with a high mortality once symptomatic. There is a difference in the way that male and female hearts remodel in the face of chronic pressure overload: women develop a concentrically hypertrophied, small cavity left ventricle (LV), whereas men are more prone to the development of eccentric hypertrophy. At a cellular level, there is an increase in collagen and metalloproteinase gene expression in males suggesting a different regulation of extracellular volume composition according to sex. Male hearts with aortic stenosis appear to have more fibrosis than their female comparators. The trigger for this appears to be in part related to estrogen receptor signaling, but other factors such as renin-angiotensin activation, nitric oxide, and circulating noradrenaline levels may also be implicated. Treatment options include surgical valve replacement (SAVR) and more recently transcatheter aortic valve replacement (TAVR). Female sex may be a risk factor for adverse outcome following SAVR and conversely appears to confer a survival advantage when undergoing TAVR. Whether the lower mortality seen following TAVR in women compared with men (despite their increased age and frailty) reflects their longer life expectancy, smaller annular size (and less post-TAVR aortic regurgitation), more favorable LV reverse remodeling, or more likely, a combination of these factors remains to be established.
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Affiliation(s)
- Laura E Dobson
- Multidisciplinary Cardiovascular Research Centre, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds , Leeds, United Kingdom
| | - Timothy A Fairbairn
- Multidisciplinary Cardiovascular Research Centre, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds , Leeds, United Kingdom
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds , Leeds, United Kingdom
| | - John P Greenwood
- Multidisciplinary Cardiovascular Research Centre, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds , Leeds, United Kingdom
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Conrotto F, D'Ascenzo F, Presbitero P, Humphries KH, Webb JG, O'Connor SA, Morice MC, Lefèvre T, Grasso C, Sbarra P, Taha S, Omedè P, Grosso Marra W, Salizzoni S, Moretti C, D'Amico M, Biondi-Zoccai G, Gaita F, Marra S. Effect of gender after transcatheter aortic valve implantation: a meta-analysis. Ann Thorac Surg 2015; 99:809-16. [PMID: 25633460 DOI: 10.1016/j.athoracsur.2014.09.089] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Revised: 09/09/2014] [Accepted: 09/19/2014] [Indexed: 02/05/2023]
Abstract
BACKGROUND The effect of gender on patients with aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) remains to be defined. METHODS MEDLINE, Cochrane Library, and Scopus databases were searched for articles describing sex differences in baseline characteristics, procedures, and outcomes. All-cause death at follow-up of at least 1 year was the primary end point, and the independent effect of female gender was evaluated with pooled analysis using a random-effect model and with meta-regression. RESULTS Six studies with 6,645 patients were included, half of them being women presenting with lower European System for Cardiac Operative Risk Evaluation (EuroSCORE) compared with men. At 30 days, more frequent major vascular complications and major and life-threatening bleeding occurred in women, with lower rates of moderate to severe aortic regurgitation, whereas 30-day mortality was similar. After a median follow-up of 365 days (range, 365 to 730 days) all-cause mortality was 24.0% in women and 34.0% in men. A pooled analysis of the multivariable approach found female gender was significantly related to a lower risk of death (odds ratio, 0.82; 95% CI, confidence interval, 0.73 to 0.93; I(2) = 0%). A meta-regression analysis showed age, ejection fraction, previous cardiovascular accident, renal insufficiency, and access site did not influence these data. CONCLUSIONS Female patients undergoing TAVI present with a lower burden of comorbidities. The counterbalance between higher rates of vascular complications but lower of valve regurgitation may explain the reduced risk for women after TAVI, independently from baseline features and access site.
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Affiliation(s)
- Federico Conrotto
- Division of Cardiology, Città Della Salute e della Scienza Hospital, Turin, Italy.
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Città Della Salute e della Scienza Hospital, Turin, Italy
| | | | - Karin H Humphries
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - John G Webb
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | - Costanza Grasso
- Division of Cardiology, Città Della Salute e della Scienza Hospital, Turin, Italy
| | - Pierluigi Sbarra
- Division of Cardiology, Città Della Salute e della Scienza Hospital, Turin, Italy
| | - Salma Taha
- Division of Cardiology, Città Della Salute e della Scienza Hospital, Turin, Italy; Division of Cardiology, Assuit University Hospital, Assuit, Egypt
| | - Pierluigi Omedè
- Division of Cardiology, Città Della Salute e della Scienza Hospital, Turin, Italy
| | - Walter Grosso Marra
- Division of Cardiology, Città Della Salute e della Scienza Hospital, Turin, Italy
| | | | - Claudio Moretti
- Division of Cardiology, Città Della Salute e della Scienza Hospital, Turin, Italy
| | - Maurizio D'Amico
- Division of Cardiology, Città Della Salute e della Scienza Hospital, Turin, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Fiorenzo Gaita
- Division of Cardiology, Città Della Salute e della Scienza Hospital, Turin, Italy
| | - Sebastiano Marra
- Division of Cardiology, Città Della Salute e della Scienza Hospital, Turin, Italy
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Giordana F, D'Ascenzo F, Nijhoff F, Moretti C, D'Amico M, Biondi Zoccai G, Sinning JM, Nickenig G, Van Mieghem NM, Chieffo A, Dumonteil N, Tchetche D, Barbash IM, Waksman R, D'Onofrio A, Lefevre T, Pilgrim T, Amabile N, Codner P, Kornowski R, Yong ZY, Baan J, Colombo A, Latib A, Salizzoni S, Omedè P, Conrotto F, La Torre M, Marra S, Rinaldi M, Gaita F. Meta-analysis of predictors of all-cause mortality after transcatheter aortic valve implantation. Am J Cardiol 2014; 114:1447-55. [PMID: 25217456 DOI: 10.1016/j.amjcard.2014.07.081] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 07/30/2014] [Accepted: 07/30/2014] [Indexed: 02/05/2023]
Abstract
The aim of this study was to identify predictors of 30-day and midterm mortality after transcatheter aortic valve implantation (TAVI) by means of a systemic review. TAVI was demonstrated to be safe and efficacious in patients with severe aortic stenosis. An accurate estimation of procedural risk of these patients represents an actual challenge. The PubMed and Cochrane Collaboration databases were systematically searched for studies reporting on the incidence and independent predictors of 30-day and midterm mortality. Adverse events were pooled with random effect, whereas independent predictors are reported as odds ratios (ORs) with 95% confidence intervals (CIs). A total of 25 studies with 8,874 patients were included (median age 82.5 ± 1.5 years, 54.6% women). At 30 days, 7.5% of patients (n = 663) died. At midterm follow-up (median 365 days, interquartile range 267 to 365 days), the cumulative mortality rate was 21.6% (n = 1,917). Acute kidney injury (AKI) stage ≥2 (OR 18.0, 95% CI 6.3 to 52), preprocedural hospitalization for heart failure (OR 9.4, 95% CI 2.6 to 35), periprocedural acute myocardial infarction (OR 8.5, 95% CI 2.6 to 33.5), and increased pro-brain natriuretic peptide (pro-BNP) levels (OR 5.4, 95% CI 1.7 to 16.5) were the most important independent predictors of 30-day mortality. Increased pro-BNP levels (OR 11, 95% CI 1.5 to 81), AKI stage 3 (OR 6.8, 95% CI 2.6 to 15.7), left ventricular ejection fraction <30% (OR 6.7, 95% CI 3.5 to 12.7), and periprocedural acute myocardial infarction (OR 6.5, 95% CI 2.3 to 18.1) represented the predictors of midterm mortality. In conclusion, in this large meta-analysis of patients undergoing TAVI, we found that high pro-BNP levels and postprocedural AKI were the strongest independent predictors of both 30-day and 1-year mortality. These findings may contribute to a better understanding of the risk assessment process of patients undergoing TAVI.
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Affiliation(s)
- Francesca Giordana
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy.
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Freek Nijhoff
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Claudio Moretti
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Maurizio D'Amico
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Giuseppe Biondi Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Jan Malte Sinning
- Medizinische Klinik und Poliklinik II, Innere Medizin, Universitätsklinikum, Bonn, Germany
| | - George Nickenig
- Medizinische Klinik und Poliklinik II, Innere Medizin, Universitätsklinikum, Bonn, Germany
| | - Nicolas M Van Mieghem
- Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Adelaide Chieffo
- Division of Metabolic and Cardiovascular Sciences, San Raffaele Scientific Institute, Milan, Italy
| | - Nicolas Dumonteil
- Pôle Cardiovasculaire et Métabolique, Hôpital Rangueil, Toulouse, France
| | - Didier Tchetche
- Department of General and Interventional Cardiology, Clinique Pasteur, Toulouse, France
| | - Israel M Barbash
- Interventional Cardiology, Division of Cardiology, Washington Hospital Center, Washington, DC
| | - Ron Waksman
- Interventional Cardiology, Division of Cardiology, Washington Hospital Center, Washington, DC
| | | | - Thierry Lefevre
- Institut Cardiovasculaire Paris Sud, Institut Hospitalier Jacques Cartier, Massy, France
| | - Thomas Pilgrim
- Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland
| | - Nicolas Amabile
- Department of Cardiology, Centre Marie Lannelongue, Le Plessis-Robinson, France
| | - Pablo Codner
- Division of Cardiology, Beilinson Hospital, Rabin Medical Center, Petach-Tikva, Israel; Tel-Aviv University, Sackler Faculty of Medicine, Tel-Aviv, Israel
| | - Ran Kornowski
- Division of Cardiology, Beilinson Hospital, Rabin Medical Center, Petach-Tikva, Israel; Tel-Aviv University, Sackler Faculty of Medicine, Tel-Aviv, Israel
| | - Ze Yie Yong
- Department of Cardiology and Cardio-Thoracic Surgery, Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands
| | - Jan Baan
- Department of Cardiology and Cardio-Thoracic Surgery, Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands
| | - Antonio Colombo
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
| | - Azeem Latib
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
| | - Stefano Salizzoni
- Division of Cardio-Surgery, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Pierluigi Omedè
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Federico Conrotto
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Michele La Torre
- Division of Cardio-Surgery, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Sebastiano Marra
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Mauro Rinaldi
- Division of Cardio-Surgery, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Fiorenzo Gaita
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
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Conrotto F, D'Ascenzo F, Salizzoni S, Presbitero P, Agostoni P, Tamburino C, Tarantini G, Bedogni F, Nijhoff F, Gasparetto V, Napodano M, Ferrante G, Rossi ML, Stella P, Brambilla N, Barbanti M, Giordana F, Grasso C, Biondi Zoccai G, Moretti C, D'Amico M, Rinaldi M, Gaita F, Marra S. A gender based analysis of predictors of all cause death after transcatheter aortic valve implantation. Am J Cardiol 2014; 114:1269-74. [PMID: 25159239 DOI: 10.1016/j.amjcard.2014.07.053] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 07/10/2014] [Accepted: 07/10/2014] [Indexed: 02/05/2023]
Abstract
The impact of gender-related pathophysiologic features of severe aortic stenosis on transcatheter aortic valve implantation (TAVI) outcomes remains to be determined, as does the consistency of predictors of mortality between the genders. All consecutive patients who underwent TAVI at 6 institutions were enrolled in this study and stratified according to gender. Midterm all-cause mortality was the primary end point, with events at 30 days and at midterm as secondary end points. All events were adjudicated according to Valve Academic Research Consortium definitions. Eight hundred thirty-six patients were enrolled, 464 (55.5%) of whom were female. At midterm follow-up (median 365 days, interquartile range 100 to 516) women had similar rates of all-cause mortality compared with men (18.1% vs 22.6%, p = 0.11) and similar incidence of myocardial infarction and cerebrovascular accident. Gender did not affect mortality also on multivariate analysis. Among clinical and procedural features, glomerular filtration rate <30 ml/min/1.73 m(2) (hazard ratio [HR] 2.55, 95% confidence interval [CI] 1.36 to 4.79) and systolic pulmonary arterial pressure >50 mm Hg (HR 2.26, 95% CI 1.26 to 4.02) independently predicted mortality in women, while insulin-treated diabetes (HR 3.45, 95% CI 1.47 to 8.09), previous stroke (HR 3.42, 95% CI 1.43 to 8.18), and an ejection fraction <30% (HR 3.82, 95% CI 1.41 to 10.37) were related to mortality in men. Postprocedural aortic regurgitation was independently related to midterm mortality in the 2 groups (HR 11.19, 95% CI 3.3 to 37.9). In conclusion, women and men had the same life expectancy after TAVI, but different predictors of adverse events stratified by gender were demonstrated. These findings underline the importance of a gender-tailored clinical risk assessment in TAVI patients.
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Affiliation(s)
- Federico Conrotto
- Division of Cardiology 2, Città della Salute e della Scienza Hospital, Turin, Italy.
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Città Della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Stefano Salizzoni
- Division of Cardiac Surgery, Città Della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | | | | | | | - Giuseppe Tarantini
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Francesco Bedogni
- Department of Cardiology, Istituto Clinico S. Ambrogio, IRCCS San Donato, Milan, Italy
| | | | - Valeria Gasparetto
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Massimo Napodano
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | | | | | | | - Nedy Brambilla
- Department of Cardiology, Istituto Clinico S. Ambrogio, IRCCS San Donato, Milan, Italy
| | - Marco Barbanti
- Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Francesca Giordana
- Division of Cardiology, Città Della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Costanza Grasso
- Division of Cardiology 2, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Giuseppe Biondi Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Claudio Moretti
- Division of Cardiology, Città Della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Maurizio D'Amico
- Division of Cardiology 2, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Mauro Rinaldi
- Division of Cardiac Surgery, Città Della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Fiorenzo Gaita
- Division of Cardiology, Città Della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Sebastiano Marra
- Division of Cardiology 2, Città della Salute e della Scienza Hospital, Turin, Italy
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Conrotto F, D'Ascenzo F, Francesca G, Colaci C, Sacciatella P, Biondi-Zoccai G, Moretti C, D'Amico M, Gaita F, Marra S. Impact of access on TAVI procedural and midterm follow-up: a meta-analysis of 13 studies and 10,468 patients. J Interv Cardiol 2014; 27:500-8. [PMID: 25196312 DOI: 10.1111/joic.12141] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Transcatheter aortic valve implantation (TAVI) may be performed using the transfemoral (TF) or transapical (TA) approach in most patients with aortic stenosis. The impact of access choice on peri-procedural and midterm results remains to be defined. METHODS Medline and Cochrane Library were searched for articles describing differences in baseline, peri-procedural, and midterm outcomes among patients undergoing TF or TA TAVI. The primary end-point was all-cause mortality after at least 1-year follow-up, while secondary end-points were 30 days mortality and in-hospital complications (bleeding and cerebrovascular events). The independent impact of access choice was evaluated with pooled analysis using a random-effect model. RESULTS Thirteen studies with 10,468 patients were included. TF was the most exploited strategy (69.5% vs. 30.5%). After adjusting for confounding variables, 30-day and midterm follow-up mortality (median 365 days, range 222-400) were lower in TF patients with a pooled adjusted odds ratio of 0.81 (0.68-0.97 I(2) 99%) and 0.85 (0.80-0.90 I(2) 96%), respectively. Regarding periprocedural outcomes, TF reduced risk of bleedings and strokes (OR of 0.74 [0.66-0.82 I(2) 95%] and 0.91 [0.83-0.99] I(2) 86%, respectively). CONCLUSIONS The TF approach reduces mortality in TAVI patients, due to lower rates of periprocedural bleedings and strokes.
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Affiliation(s)
- Federico Conrotto
- Division of Cardiology, Città della Salute e della Scienza Hospital, Turin, Italy
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STANGL VERENA, BALDENHOFER GERD, LAULE MICHAEL, BAUMANN GERT, STANGL KARL. Influence of Sex on Outcome Following Transcatheter Aortic Valve Implantation (TAVI): Systematic Review and Meta-Analysis. J Interv Cardiol 2014; 27:531-9. [DOI: 10.1111/joic.12150] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- VERENA STANGL
- Medizinische Klinik für Kardiologie und Angiologie; Campus Mitte, Charité-Universitätsmedizin Berlin; Berlin Germany
- DZHK (German Center for Cardiovascular Research); Berlin Germany
| | - GERD BALDENHOFER
- Medizinische Klinik für Kardiologie und Angiologie; Campus Mitte, Charité-Universitätsmedizin Berlin; Berlin Germany
| | - MICHAEL LAULE
- Medizinische Klinik für Kardiologie und Angiologie; Campus Mitte, Charité-Universitätsmedizin Berlin; Berlin Germany
| | - GERT BAUMANN
- Medizinische Klinik für Kardiologie und Angiologie; Campus Mitte, Charité-Universitätsmedizin Berlin; Berlin Germany
| | - KARL STANGL
- Medizinische Klinik für Kardiologie und Angiologie; Campus Mitte, Charité-Universitätsmedizin Berlin; Berlin Germany
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Siontis GC, Jüni P, Pilgrim T, Stortecky S, Büllesfeld L, Meier B, Wenaweser P, Windecker S. Predictors of Permanent Pacemaker Implantation in Patients With Severe Aortic Stenosis Undergoing TAVR. J Am Coll Cardiol 2014; 64:129-40. [DOI: 10.1016/j.jacc.2014.04.033] [Citation(s) in RCA: 371] [Impact Index Per Article: 37.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 02/10/2014] [Accepted: 04/03/2014] [Indexed: 01/31/2023]
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Haussig S, Schuler G, Linke A. Worldwide TAVI registries: what have we learned? Clin Res Cardiol 2014; 103:603-12. [PMID: 24648061 DOI: 10.1007/s00392-014-0698-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 03/03/2014] [Indexed: 01/27/2023]
Abstract
With a rapidly aging society, the number of patients with cardiovascular disease-in particular aortic stenosis-is progressively increasing. Although conventional aortic valve replacement remains the only treatment known to improve prognosis and symptoms in symptomatic patients with aortic stenosis, about one-third are still withhold from the life-saving therapy. Based on the compelling evidence of the randomized Placement of Aortic transcatheter valves (PARTNER) A and B cohort, TAVI is now considered standard of care for extreme risk and inoperable patients and is an alternative to surgery for high-risk patients with symptomatic aortic stenosis. However, these patients were super-selected, which does not reflect a clinical real-world situation. TAVI registries represent a real-world scenario, and therefore provide the evidence for the treatment of high-risk patients (regarding comorbidities and anatomical factors) in daily clinical life. The review will focus on the recently published Edwards SAPIEN, Medtronic CoreValve and mixed (national) registries with the focus on short- and midterm outcome. These registries suggest that the growing experience of the operators with regard to patient selection, prevention, recognition and treatment of procedural complications together with the developments in valve design will improve the short-term results of TAVI. However, randomized trials in intermediate risk patients and data on long-term valve durability are a prerequisite before indications can be expanded to younger and lower risk patient population.
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Affiliation(s)
- Stephan Haussig
- Department of Internal Medicine/Cardiology, Heart Center, University of Leipzig, Strümpellstrasse 39, 04289, Leipzig, Germany
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Effect of gender differences on 1-year mortality after transcatheter aortic valve implantation for severe aortic stenosis: results from a multicenter real-world registry. Clin Res Cardiol 2014; 103:613-20. [DOI: 10.1007/s00392-014-0690-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 02/17/2014] [Indexed: 10/25/2022]
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Al-Lamee R, Broyd C, Parker J, Davies JE, Mayet J, Sutaria N, Ariff B, Unsworth B, Cousins J, Bicknell C, Anderson J, Malik IS, Chukwuemeka A, Blackman DJ, Moat N, Ludman PF, Francis DP, Mikhail GW. Influence of gender on clinical outcomes following transcatheter aortic valve implantation from the UK transcatheter aortic valve implantation registry and the National Institute for Cardiovascular Outcomes Research. Am J Cardiol 2014; 113:522-8. [PMID: 24326271 DOI: 10.1016/j.amjcard.2013.10.024] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 10/15/2013] [Accepted: 10/15/2013] [Indexed: 01/09/2023]
Abstract
Gender differences exist in outcomes after percutaneous coronary intervention and coronary artery bypass graft surgery but have yet to be fully explored after transcatheter aortic valve implantation. We aimed to investigate gender differences after transcatheter aortic valve implantation in the UK National Institute for Cardiovascular Outcomes Research registry. A retrospective analysis was performed of Medtronic CoreValve and Edwards SAPIEN implantation in 1,627 patients (756 women) from January 2007 to December 2010. Men had more risk factors: poor left ventricular systolic function (11.9% vs 5.5%, p <0.001), 3-vessel disease (19.4% vs 9.2%, p <0.001), previous myocardial infarction (29.5% vs 13.0%, p <0.001), peripheral vascular disease (32.4% vs 23.3%, p <0.001), and higher logistic EuroSCORE (21.8 ± 14.2% vs 21.0 ± 13.4%, p = 0.046). Thirty-day mortality was 6.3% (confidence interval 4.3% to 7.9%) in women and 7.4% (5.6% to 9.2%) in men and at 1 year, 21.9% (18.7% to 25.1%) and 22.4% (19.4% to 25.4%), respectively. There was no mortality difference: p = 0.331 by log-rank test; hazard ratio for women 0.91 (0.75 to 1.10). Procedural success (96.6% in women vs 96.4% in men, p = 0.889) and 30-day cerebrovascular event rates (3.8% vs 3.7%, p = 0.962) did not differ. Women had more major vascular complications (7.5% vs 4.2%, p = 0.004) and less moderate or severe postprocedural aortic regurgitation (7.5% vs 12.5%, p = 0.001). In conclusion, despite a higher risk profile in men, there was no gender-related mortality difference; however, women had more major vascular complications and less postprocedural moderate or severe aortic regurgitation.
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