Sex Differences in the Utilization and Outcomes of Surgical Aortic Valve Replacement for Severe Aortic Stenosis

Abstract

BackgroundStudies assessing the differential impact of sex on outcomes of aortic valve replacement (AVR) yielded conflicting results. We sought to investigate sex‐related differences in AVR utilization, patient risk profile, and in‐hospital outcomes using the Nationwide Inpatient Sample.Methods and ResultsIn total, 166 809 patients (63% male and 37% female) who underwent AVR between 2003 and 2014 were identified, and 48.5% had a concomitant cardiac surgery procedure. Compared with men, women were older and had more nonatherosclerotic comorbid conditions including hypertension, diabetes mellitus, obstructive pulmonary disease, atrial fibrillation/flutter, and anemia but fewer incidences of coronary and peripheral arterial disease and prior sternotomies. In‐hospital mortality was significantly higher in women (5.6% versus 4%, P<0.001). Propensity matching was performed to assess the impact of sex on the outcomes of isolated AVR and yielded 28 237 matched pairs of male and female participants. In the propensity‐matched groups, in‐hospital mortality was higher in women (3.3% versus 2.9%, P<0.001). Along with vascular complications and blood transfusion (6% versus 5.6%, P=0.027 and 40.4% versus 33.9%, P<0.001, respectively). Rates of stroke, permanent pacemaker implantation, and acute kidney injury requiring dialysis were similar (2.4% versus 2.4%, P=0.99; 6% versus 6.3%, P=0.15; and 1.4% versus 1.3%, P=0.14, respectively). Length of stay median and interquartile range were both similar between groups (7±6 days). Rates of nonhome discharge were higher among women (27.9% versus 19.6%, P<0.001).ConclusionsWomen have worse in‐hospital mortality following AVR compared with men. Coupled with the accumulating evidence suggesting higher magnitude of benefit of transcatheter AVR over AVR in women, women should perhaps be offered transcatheter AVR over AVR at a lower threshold than men.

Contemporary Trends in the Use and Outcomes of Surgical Treatment of Tricuspid Regurgitation

“…These cost values, nevertheless, are ≈2‐fold higher than parallel cost data published from the NIS for isolated aortic and mitral valve surgical procedures 41. These data may be encouraging to the rising transcatheter TV therapies.…”

Transcatheter aortic valve replacement in women

“…Existing data show that not only do women undergo SAVR for aortic stenosis less frequently than men, but when they do, they have worse outcomes with SAVR than do men . SAVR in women has been associated with worse in‐hospital mortality and higher cost compared with men.…”

Time course of the survival advantage of transcatheter over surgical aortic valve replacement: Interplay between sex and patient risk profile

“…Yet, women undergo SAVR for AS less frequently than men, and have worse outcomes with it than men. 2,3 Transcatheter aortic valve replacement (TAVR) has been recognized as a well-established alternative to SAVR in patients with AS who are of intermediate and high risk or inoperable for severe AS. 4,5 It is noteworthy that unlike coronary artery disease trials, where women are underrepresented, 6 in TAVR studies women are not only treated as often as men, 7-10 but also showed mortality benefit after TAVR despite higher rates of short-term adverse outcomes, particularly major vascular complications, bleeding events and stroke.…”