Sex Differences in Transfemoral Transcatheter Aortic Valve Replacement

J Am Coll Cardiol. 2019 Dec 3;74(22):2758-2767. doi: 10.1016/j.jacc.2019.09.015. Epub 2019 Sep 25.

Abstract

Background: Transfemoral aortic valve replacement (TAVR) is a guideline-recommended treatment option for patients with severe aortic valve stenosis. Women and men present with different baseline characteristics, which may influence procedural outcomes.

Objectives: This study sought to evaluate differences between women and men undergoing transfemoral TAVR across the globe during the last decade.

Methods: The CENTER (Cerebrovascular EveNts in patients undergoing TranscathetER aortic valve implantation with balloon-expandable valves versus self-expandable valves)-collaboration was a global patient level dataset of patients undergoing transfemoral TAVR (N = 12,381) from 2007 to 2018. In this retrospective analysis, the study examined differences in baseline patient characteristics, 30-day stroke and mortality, and in-hospital outcomes between female and male patients. The study also assessed for temporal changes in outcomes and predictors for mortality per sex.

Results: We included 58% (n = 7,120) female and 42% (n = 5,261) male patients. Women had higher prevalence of hypertension and glomerular filtration rate <30 ml/min/1.73 m2 but lower prevalence of all other traditional cardiovascular comorbidities. Both sexes had similar rates of 30-day stroke (2.3% vs. 2.5%; p = 0.53) and mortality (5.9% vs. 5.5%; p = 0.17). In contrast, women had a 50% higher risk of life-threatening or major bleeding (6.7% vs. 4.4%; p < 0.01). Over the study period, mortality rates decreased to a greater extent in men than in women (60% vs. 50% reduction; both p < 0.001), with no reductions in stroke rates over time.

Conclusions: In this global collaboration, women and men had similar rates of 30-day mortality and stroke. However, women had higher rates of procedural life-threatening or major bleeding after TAVR. Between 2007 and 2018, mortality rates decreased to a greater extent in men than in women.

Keywords: outcome differences over time; predictors of 30-day mortality; sex differences; transfemoral aortic valve implantation.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aortic Valve / surgery*
  • Aortic Valve Stenosis / surgery*
  • Catheterization, Peripheral / methods*
  • Europe / epidemiology
  • Female
  • Femoral Artery
  • Humans
  • Male
  • Postoperative Complications
  • Prognosis
  • Prospective Studies
  • Risk Assessment / methods*
  • Risk Factors
  • Sex Distribution
  • Sex Factors
  • Survival Rate / trends
  • Transcatheter Aortic Valve Replacement / methods*