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TAVR may be favorable for women vs. surgical AVR
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For women with high risk for complications, transcatheter aortic valve replacement may be a better option compared with surgical AVR, according to a study published in Catheterization and Cardiovascular Interventions.
However, higher costs and increased risk of need for extracorporeal membrane oxygen should be considered, researchers wrote.
Being female is a risk factor related to worse outcomes in cardiac surgery, and the outcomes of women vs. men in TAVR and surgical AVR is controversial, the researchers wrote.
“Although outcomes of females vs. males in either TAVR or SAVR have been investigated, the comparative outcomes of TAVR vs. SAVR in large female populations are limited,” Tomo Ando, MD, of Wayne State University and the division of cardiology at Harper Hospital and Detroit Medical Center, and colleagues wrote. “Females exhibit different perioperative complication patterns compared to males, and therefore the optimal modes of aortic valve replacement in female patients remain undetermined.”
To further investigate therapeutic options between TAVR and surgical AVR in a female population, Ando and colleagues used the Nationwide Inpatient Sample database to gather data on patients who received TAVR or surgical AVR between 2011 and 2014.
A total of 3,064 TAVR and 18,594 surgical AVR female patients were included in the analysis, which had a primary endpoint of in-hospital all-cause mortality and secondary endpoints of perioperative complications.
The primary endpoint was similar between the TAVR and surgical AVR cohorts (4.2% vs. 3.9%, respectively; P=.89), the researchers wrote.
Female TAVR patients had less hemorrhage requiring transfusion (12% vs. 21%; P<.001), perioperative cardiac arrest and nonfatal MI (9.8% vs. 17%; P<.001), respiratory complications (1.6% vs. 4.4%; P<.001), postoperative sepsis (1.7% vs. 2.9%; P=.03) acute MI (3% vs. 4.9%; P<.001), and acute kidney injury (15% vs. 18%; P<.001) compared with women who underwent surgical AVR.
There was an increased risk for new pacemaker implantation among female TAVR patients (11% vs. 5.9%; P<.001) and use of extracorporeal membrane oxygenation (0.66% vs. 0.24%; P<.001).
TAVR patients had less nonroutine discharge and a higher in-hospital cost vs. surgical AVR patients (median, $51,274 vs. $43,677; P<.001), but the length of stay was shorter (mean, 7.8 days vs. 10.5 days), according to the researchers.
According to Ando and colleagues, there are several limitations to recognize when interpreting the results of the study, including the possibility of Nationwide Inpatient Sample coding errors, limited outcomes, the exclusion of newer-generation prosthetic valves, unreported and unknown variables and unclassified stroke severity. – by Dave Quaile
Disclosures: The authors report no relevant financial disclosures.
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