Bibliographic Details
| Title: |
Gender Differences after Transcatheter Aortic Valve Replacement (TAVR): Insights from the Italian Clinical Service Project |
| Authors: |
Andrea Denegri, Michele Romano, Anna Sonia Petronio, Marco Angelillis, Cristina Giannini, Claudia Fiorina, Luca Branca, Marco Barbanti, Giuliano Costa, Nedy Brambilla, Valentina Mantovani, Matteo Montorfano, Luca Ferri, Giuseppe Bruschi, Bruno Merlanti, Bernhard Reimers, Carlo Pivato, Arnaldo Poli, Carmine Musto, Massimo Fineschi, Diego Maffeo, Carlo Trani, Flavio Airoldi, Corrado Lettieri |
| Source: |
Journal of Cardiovascular Development and Disease, Vol 8, Iss 9, p 114 (2021) |
| Publisher Information: |
MDPI AG, 2021. |
| Publication Year: |
2021 |
| Collection: |
LCC:Diseases of the circulatory (Cardiovascular) system |
| Subject Terms: |
aortic stenosis, TAVR, gender differences, sex differences, women, Medtronic, Diseases of the circulatory (Cardiovascular) system, RC666-701 |
| More Details: |
Background: TAVR is a safe alternative to surgical aortic valve replacement (SAVR); however, sex-related differences are still debated. This research aimed to examine gender differences in a real-world transcatheter aortic valve replacement (TAVR) cohort. Methods: All-comer aortic stenosis (AS) patients undergoing TAVR with a Medtronic valve across 19 Italian sites were prospectively included in the Italian Clinical Service Project (NCT01007474) between 2007 and 2019. The primary endpoint was 1-year mortality. We also investigated 3-year mortality, and ischemic and hemorrhagic endpoints, and we performed a propensity score matching to assemble patients with similar baseline characteristics. Results: Out of 3821 patients, 2149 (56.2%) women were enrolled. Compared with men, women were older (83 ± 6 vs. 81 ± 6 years, p < 0.001), more likely to present severe renal impairment (GFR ≤ 30 mL/min, 26.3% vs. 16.3%, p < 0.001) but had less previous cardiovascular events (all p < 0.001), with a higher mean Society of Thoracic Surgeons (STS) score (7.8% ± 7.1% vs. 7.2 ± 7.5, p < 0.001) and a greater mean aortic gradient (52.4 ± 15.3 vs. 47.3 ± 12.8 mmHg, p < 0.001). Transfemoral TAVR was performed more frequently in women (87.2% vs. 82.1%, p < 0.001), with a higher rate of major vascular complications and life-threatening bleeding (3.9% vs. 2.4%, p = 0.012 and 2.5% vs. 1.4%, p = 0.024). One-year mortality differed between female and male (11.5% vs. 15.0%, p = 0.002), and this difference persisted after adjustment for significant confounding variables (Adj.HR1yr 1.47, 95%IC 1.18–1.82, p < 0.001). Three-year mortality was also significantly lower in women compared with men (19.8% vs. 24.9%, p < 0.001) even after adjustment for age, STS score, eGFR, diabetes and severe COPD (Adj.HR3yr 1.42, 95%IC 1.21–1.68, p < 0.001). These results were confirmed in 689 pairs after propensity score matching. Conclusion: Despite higher rates of peri-procedural complications, women presented better survival than men. This better adaptive response to TAVR may be driven by sex-specific factors. |
| Document Type: |
article |
| File Description: |
electronic resource |
| Language: |
English |
| ISSN: |
2308-3425 |
| Relation: |
https://www.mdpi.com/2308-3425/8/9/114; https://doaj.org/toc/2308-3425 |
| DOI: |
10.3390/jcdd8090114 |
| Access URL: |
https://doaj.org/article/6a522c0f26b0423da797677edfa46439 |
| Accession Number: |
edsdoj.6a522c0f26b0423da797677edfa46439 |
| Database: |
Directory of Open Access Journals |
