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Women fare better than men after TAVI

Hayashida K. J Am Coll Cardiol. 2012;59:566-571.

Issue: March 2012

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Results of a small study suggest that women with severe aortic stenosis have improved survival after undergoing transcatheter aortic valve replacement when compared with men.

As transcatheter aortic valve implantation (TAVI) grows in popularity worldwide, researchers in France conducted a study to examine the impact of sex-related differences with TAVI in high-risk patients with severe aortic stenosis.

From October 2006 to December 2010, researchers analyzed data on 260 patients (mean age, 83.1 years) with severe aortic stenosis who underwent TAVI using commercially available bioprostheses (Cribier-Edwards, Edwards Sapien and Sapien XT, Edwards Lifesciences; CoreValve, Medtronic) through the subclavian, transapical or transfemoral route. Patients were enrolled in the study if they had a logistic EuroSCORE of more than 20% or if surgery was deemed high risk.

According to results, device success was achieved in 89.6% of the cohort, without significant sex-related differences (90.8% vs. 88.4%; P=.516). Researchers found no significant difference in the rate of major vascular complications (11.5% vs. 9.3%; P=.570). However, women (9%) experienced more iliac complications vs. men (9% vs. 2.5%; P=.03). Women also had higher post-procedural left ventricular ejection fraction at discharge (56.8 vs. 51; P<.001). Mean aortic pressure gradient was similar in women and men (11.6 vs. 10.9; P=.279).

Overall, 79 patients died during the follow-up period. Researchers found no significant difference in 30-day mortality rate between women and men (12.2% vs. 17.8%; P=.207) or 30-day combined safety point (14.5% vs. 20.2%; P=.231).

“Although no relation with the 30-day mortality rate was observed, female sex was associated with better midterm survival after TAVI,” the researchers wrote.

The 1-year survival rate was 76% in women vs. 65% in men. Cox regression analysis showed that men experienced higher rates of midterm mortality (HR=1.62; 95% CI, 1.03-2.53). The researchers said these higher survival rates in women may be explained by longer life expectancy and a lower rate of comorbidities.

Women had better baseline characteristics than men in this study. Women had less coronary and peripheral disease, less previous cardiac surgery, higher ejection fraction and lower EuroSCORE compared with men (22.3% vs. 26.2%; P=.005).

“Despite women having a smaller body and femoral, aortic and aortic annulus size, similar device success was achieved in women and men alike with an adequate reduction in the transprosthetic pressure gradient,” the researchers concluded.

Disclosure: Dr. Hayashida is supported by an educational bursary from Banyu Life Science Foundation International, Tokyo. Dr. Chevalier is a consultant for Abbott Vascular. Drs. Romano and Lefevre are proctors for Edwards TAVI.

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