Risk and Outcome of Aortic Valve Surgery in the Transcatheter Valve Era: The Gender Aspect

Abstract

Results: Women in group II were significantly younger (71.6 ± 9.0 years; p = 0.004) and showed significantly lower risk profiles (logistic EuroSCORE: 9.6 ± 9.9%; p = 0.04) than women in group I (age: 75.6 ± 8.5 years, logistic EuroSCORE: 13.9 ± 15.9). Men's age and risk profiles remained similar in both groups. Observed survival at 30 days was 98.8% in group II and 95.8% in group I which represented a statistical trend (p = 0.09). Female survival in group I was 92.2% and significantly worse as compared to 99% male survival in group I (p = 0.03). This significant difference in gender ratio of mortality was not detected in group II (female survival 97%, male survival 100%; p = 0.2). Being female was a significant risk factor in group I (odds ratio; 8.4; p = 0.03) but not in group II any longer (odds ratio: 1.0; p = 0.2). Conclusions: The possibility of transcatheter aortic valve replacement for therapy of aortic stenosis has led to a lower risk and improved outcome of surgical aortic valve replacement especially for women.

The Outcomes for Different Biological Heart Valve Prostheses in Surgical Aortic Valve Replacement before and after the Introduction of Transcatheter Aortic Valve Implantation

“…Closely related to the first observation is the significant increase in patients over 80 years, for both i-SAVR and c-SAVR. This trend related to an increase in patient age was already visible before the introduction of TAVI [10] and has also been documented in several more recently published patient series, with an increase of at least one year in age after the introduction of TAVI [17,21,24,26,27,36,[40][41][42][43], or an increase in the octogenarian group [44]. However, there is no uniformity in this respect.…”

“…However, there is no uniformity in this respect. A decrease in age of at least one year [25,32,38,42,45], or no significant change [12,20,28,33], was documented in several other series. In one series, an initial increase in the referral of octogenarians for SAVR was followed by a decline [46].…”

“…The need for a second valvular procedure (through SAVR or through TAVI) was seen in 54 (2.5%) of the patients at a mean of 113 months. The durability of the Mitroflow valve with 11 events at a mean of 73 (65-81) months and the Crown valve with 10 events at a mean of 48 (38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55)(56)(57) months were considerably worse and the use, therefore, was discontinued. For the Perceval device, the number of observations was too low for any analysis concerning SVD, which could be related to the high age and consequently a lower life expectancy.…”

Snemmkominn árangur opinna ósæðarlokuskipta við ósæðarlokuþrengslum hjá konum á Íslandi

“…Svipuðu hlutfalli hefur verið lýst erlendis 17,18,21,22 þótt sumar rannsóknir sýni allt að 4047% hlutfall kvenna. 19,20,23,24 Ástaeða laegra hlutfalls kvenna hér á landi er ekki augljós en erlendis hafa rannsóknir R A N N S Ó K N sýnt að konum sé síður vísað í hjartaaðgerðir sökum óljósra ein kenna. 32,33 Konur þróa einnig síðar með sér kransaeðasjúkdóm mið að við karla, 34 sem endurspeglast í rannsókn okkar, en þrátt fyrir haerri aldur gengust faerri konur undir kransaeðahjáveitu samtímis lokuskiptum.…”

“…Af sömu ástaeðu var EuroSCORE II kvenna fyrir að gerð marktaekt haerra, en karla en kvenkyn og aldur eru sjálfstaeðir forspárþaettir í þessu spálíkani. 19,20,35 Lokuflatarmál fyrir aðgerð var marktaekt minna hjá konum fyr ir aðgerð en sambaerilegt þegar leiðrétt var fyrir heildarlíkams yfirborði einstaklingsins. Hjartaómskoðun fyrir aðgerð sýndi hins vegar að konur voru með haerra þrýstingsfall yfir lokuna.…”