Aim To assess gender differences in in-hospital mortality and 90-day readmission rates among patients undergoing Transcatheter aortic valve replacement (TAVR) in the United States. Methods and Results Hospitalizations for TAVR were retrospectively identified in the National readmissions database (NRD) from 2012-2017. Gender based differences in in-hospital mortality and 90-day readmissions were explored using multivariable logistic regression models. During the study period, an estimated 171,361 hospitalizations for TAVR were identified, including 79,722 (46.5%) procedures in women and 91,639 (53.5%) in men. Unadjusted in-hospital mortality and 90-day all-cause readmissions were significantly higher for women compared to men (2.7% vs. 2.3%, p = .002; 25.1% vs. 24.1%; p = .012 respectively). After adjusting for baseline characteristics, women had 13% greater adjusted odds of in-hospital mortality (aOR: 1.13, 95% CI: 1.02-1.26, p = .017), and 9% greater adjusted odds of 90-day readmission compared to men (aOR: 1.09, 95% CI: 1.05-1.14, p < .001). During the study period, there was a steady decrease in hospital mortality (5.3% in 2012 to 1.6% in 2017; ptrend < .001) and 90-day (29.9% in 2012 to 21.7% in 2017; ptrend < .001) readmission rate in both genders. Conclusion In-hospital mortality and readmission rates for TAVR hospitalizations have decreased over time across both genders. Despite these improvements, women undergoing TAVR continue to have a modestly higher in-hospital mortality, and 90-day readmission rates compared to men. Given the expanding indications and use of TAVR, further research is necessary to identify the reasons for this persistent gap and design appropriate interventions.

Only a few case reports to date have described patients with three or more cancers. However, the incidence of multiple primary malignancies is increasing due to the improved survival of cancer patients, the prolonged lifespan of the general population, and better diagnostic techniques. This report describes a 73-year-old woman with primary breast, rectal squamous cell, and renal cell carcinomas. This case is unique because, in addition to having three primary malignancies, this patient had rectal squamous cell carcinoma—one of the rarest types of rectal cancer. We discuss screening and prevention of multiple malignancies and rectal squamous cell carcinoma, as well as methods for managing these patients.

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Background Redo surgical aortic valve replacement (redo SAVR) and valve‐in‐valve transcatheter aortic valve replacement (ViV TAVR) are the two treatment strategies available for patients with severe symptomatic bioprosthetic aortic valve dysfunction. Herein, we performed a systematic review and meta‐analysis comparing both early and mid‐term outcomes of ViV TAVR versus redo SAVR in patients with bioprosthetic aortic valve disease. Methods PubMed, Cochrane reviews, and Google scholar electronic databases were searched and studies comparing ViV TAVR versus redo SAVR were included. The primary outcome of interest was mid‐term (1–5 years) and 1‐year all‐cause mortality. Secondary outcomes included were 30‐day all‐cause mortality, myocardial infarction, pacemaker implantation, stroke, acute kidney injury, major or life‐threatening bleeding, and postprocedural aortic valve gradients. Pooled risk ratios (RR) with their corresponding 95% confidence intervals (CIs) were calculated for all outcomes using the DerSimonian–Laird random‐effects model. Results Nine observational studies with a total of 2,891 individuals and mean follow‐up of 26 months met the inclusion criteria. There is no significant difference in mid‐term and 1‐year mortality between ViV‐TAVR and redo SAVR groups with RR of 1.15 (95% CI 0.99–1.32; p = .06) and 1.06 (95% CI 0.69–1.61; p = .8). 30‐day mortality rate was significantly lower in ViV‐TAVR group with RR of 0.65 (95% CI 0.45–0.93; p = .02). ViV‐TAVR group had lower 30‐day bleeding, length of stay, and higher postoperative gradients. Conclusion Our study demonstrates a lower 30‐day mortality and similar 1‐year and mid‐term mortality for ViV TAVR compared to redo SAVR despite a higher baseline risk. Given these findings and the ongoing advances in the transcatheter therapeutics, VIV TAVR should be preferred over redo SAVR particularly in those at intermediate‐high surgical risk.

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