Female gender and the clinical and periprocedural profile and clinical outcomes of transcatheter aortic valve implantation: experiences of a tertiary Polish centre

Abstract

Introduction Despite the establishment of multiple factors influencing short- and mid-term outcomes in patients treated with transcatheter aortic valve implantation (TAVI), the real-world data on the association between gender and outcomes after TAVI remain conflicting. Aim To evaluate the association of female gender with the clinical and periprocedural characteristics along with in-hospital, short- and medium-term outcomes of patients treated with TAVI in comparison with male patients. Material and methods Data from the prospective, single-centre registry of consecutive patients with severe AS referred for TAVI from 26 November 2008 to 31 December 2018 were analysed retrospectively. The study population comprised 275 patients who were divided by gender. The primary endpoint of the study was all-cause mortality at 1 year. Results Women constituted 132 (48.0%) of the overall population. Women were significantly older, but had a significantly higher left ventricular ejection fraction (LVEF) and had less frequently undergone coronary artery bypass grafting (CABG) before TAVI. The implantation success rate was comparable between genders, but women less frequently required implantation of a pacemaker after TAVI, although they more frequently required blood transfusion due to severe bleeding. The primary endpoint occurred in 13.6% of women and 7.7% of men ( p = 0.12). Conclusions Despite advanced age and prevalence of cardiovascular risk factors, the overall short- and medium-term mortality in patients treated with TAVI in our analysis of the real-world population remains relatively low. Although women seemed to have a slightly better clinical baseline profile, their in-hospital, 30-day, 6-month and 12-month outcomes did not differ significantly from the male patients.

Sex-Related Differences in Postoperative Outcomes After Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis

“…AKI was reported in 14 studies, 16–18,21,22,24,29,31,32,35,37,38,41,42 with significantly higher rates of AKI found in males in 3 studies. 17,22,29 Rates of AKI in these studies ranged from 3.66% to 26% and 2.13% to 14% for males and females, respectively ( P = 0.04–0.001).…”

“…A total of 28 16–43 studies were included that investigated the differences in outcomes between males and females undergoing TAVR. All included studies had a combined total of 156 275 patients with data collection dates ranging from 2004 to 2020.…”

“…One-year mortality ranged from 7.7% to 26.6% in males and 7.0% to 27.9% in females from 17 studies. 16,[18][19][20][21]23,24,26,29,[31][32][33][34]37,38,41,43 Five studies found significantly higher mortality, ranging from 12.7% to 25.9% in males and 7.0% to 19.0% (P = 0.004 to <0.001) in females. 29,[32][33][34]43 Pooled data of 1-year mortality were not significantly different between males and females with an OR of 1.13 (95% CI, 0.96-1.34; Z score, 1.48; P = 0.14).…”

“…In-hospital mortality was reported in 12 studies with rates ranging from 0% to 9.3% and 0.5% to 7.3% for males and females, respectively. 17,19,27,32,33,[35][36][37][39][40][41][42] Two studies reported significant increased rates of mortality for females when compared with males. 17,35 Mortality in these studies ranged from 0.9% to 3.1% for males and 1.6% to 4.19% for females (P = 0.036 to <0.001).…”

“…Sixteen studies provided MI data post-TAVR [17][18][19]21,[23][24][25]29,30,33,34,[37][38][39]41,42 with only one study 19 identifying significant differences between males and females. In this study, 2.1% of males and 0.3% of females had a post-TAVR MI (P = 0.03).…”