This article is more than 5 years old. Information may no longer be current.

In-hospital mortality more common in women after TAVR

Add topic to email alerts

Receive an email when new articles are posted on

Please provide your email address to receive an email when new articles are posted on .

Subscribe

Added to email alerts

You've successfully added to your alerts. You will receive an email when new content is published.

Click Here to Manage Email Alerts

You've successfully added to your alerts. You will receive an email when new content is published.

Click Here to Manage Email Alerts

Back to Healio

We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com.

Back to Healio

Sonia Shah

ANAHEIM, Calif. — Women who underwent transcatheter aortic valve replacement for aortic valve disease had increased risk for in-hospital mortality compared with men, according to data presented at the American Heart Association Scientific Sessions.

Sonia Shah, MD, resident physician at Stanford Medical Center in California, and colleagues analyzed data from 2,705 patients (mean age for women, 82 years; mean age for men, 81 years; 48% women) from the National Inpatient Sample who underwent TAVR in 2013.

“We specifically chose this year because the FDA approved the Sapien valve (Edwards Lifesciences) in mid-2012 for high-risk patients with severe symptomatic aortic stenosis,” Shah said.

Unadjusted rates of transcutaneous pacer requirement (P = .14), permanent pacemaker (P = .62) and MI (P = .52) did not significantly differ between men and women. There was no difference between men and women regarding risk for pacemaker implantation (OR = 1.12; 95% CI, 0.93-1.38).

All-cause mortality (5.6% vs. 4%; P = .05) and vascular complications (P = .03) occurred more often in women vs. men.

After adjusting for baseline characteristics — women had lower Charlson comorbidity scores than men (2.5 vs. 2.9; P < .0001) — the rate of all-cause mortality increased further in women vs. men (OR = 1.64; 95% CI, 1.1-2.44).

“Some possible reasons are higher incidence of vascular complications, and there are studies that have shown that vascular complications are linked with a higher in-hospital mortality rate,” Shah said. “Potentially contributing factors are catheter vs. coronary vessel, which as we’ve seen, women have a smaller groin vessel size. In theory, as we’re developing new catheters that are theoretically smaller, this complication rate may go down in the future. Another factor is the TAVR approach. Prior studies have shown that women are more likely to undergo the transapical approach. We’ve seen that this is linked with a higher mortality rate as well.

“Overall, further studies on vascular biology and physiologic differences in sex are needed in the TAVR population to improve gender differences and outcomes in women specifically in the periprocedural period,” Shah said. “We’re also looking into trends in mortality outcomes as well as identifying potentially modifiable risk factors to improve vascular complications.” – by Darlene Dobkowski

Reference:

Shah S, et al. Gender Disparities and Women’s Cardiovascular Disease. Presented at: American Heart Association Scientific Sessions; Nov. 11-15, 2017; Anaheim, Calif.

Disclosures: The authors report no relevant financial disclosures.