Sex-Specific Differences in Outcome of Transcatheter or Surgical Aortic Valve Replacement

Kaier, Klaus; Mühlen, Constantin von zur; Zirlik, Andreas; Schmoor, Claudia; Roth, Katrin; Bothe, Wolfgang; Hehn, Philip; Reinöhl, Jochen; Zehender, Manfred; Bode, Christoph; Stachon, Peter

doi:10.1016/j.cjca.2018.04.009

Cited by 28 publications

(41 citation statements)

References 24 publications

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“…Since Alain Cribier performed the first transcatheter aortic valve replacement (TAVR) in a patient with a cardiogenic shock due to severe aortic stenosis, 1 the treatment of aortic valve stenosis has developed rapidly toward TAVR. 2 Several randomized controlled trials and large registries showed benefits of TAVR regarding mortality and complications in patients with increased operative risk. [3][4][5][6] The latest guidelines recommend TAVR for patients with severe aortic valve stenosis over an age of 75 years at increased risk.…”

Section: Introductionmentioning

confidence: 99%

Nationwide outcomes of aortic valve replacement for pure aortic regurgitation in Germany 2008–2015

Stachon

Kaier

Heidt

et al. 2019

Cathet Cardio Intervent

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Background Transcatheter aortic valve replacement (TAVR) is routinely used in patients with severe aortic stenosis at increased operative risk. Due to potential technical difficulties, TAVR is not recommended for pure aortic regurgitation (AR). Smaller studies reported its use in AR, but data from big registries are lacking. The present study analyzes the nationwide use of surgical aortic valve replacement (SAVR) and TAVR in patients with AR from 2008 until 2015. Methods We identified 138,237 cases of aortic valve replacement in Germany based on ICD and OPS codes. Results Of 13.2% SAVR‐cases and 1.3% of TAVR cases were performed in AR. AR patients undergoing SAVR were younger with lower logistic EuroSCORE (stenosis: 6.1 ± 5.6; AR: 4.5 ± 4.9). Nevertheless, stroke rates, bleedings, prolonged mechanical ventilation, and in‐hospital mortality were higher (mortality: stenosis 2.6%, AR: 4.7%). In the TAVR group, patients with AR were at higher operative risk (logistic EuroSCORE: transfemoral (TF)‐TAVR: stenosis: 14.3 ± 10.4; AR: 17.3 ± 13.3. Transapical (TA)‐TAVR: stenosis: 16.1 ± 11.4; AR: 15.7 ± 12.2). Stroke rates were lower, but bleedings and prolonged ventilation occurred more frequently after TF‐TAVR in AR compared to stenosis. The mortality varied markedly (TF‐TAVR: 15.2% in 2011; 2.8% in 2015; TA‐TAVR: 17.7% in 2012 and 0% in 2014). Conclusion TAVR is off‐label used in AR in clinical practice. TAVR seems to be a safe option for AR with regard to in‐hospital outcomes. However, further research evaluating long‐term outcomes is required to establish the feasibility of TAVR in pure AR.

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Section: Introductionmentioning

confidence: 99%

Nationwide outcomes of aortic valve replacement for pure aortic regurgitation in Germany 2008–2015

Stachon

Kaier

Heidt

et al. 2019

Cathet Cardio Intervent

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“…A large study from a German registry of over 25 000 patients who underwent TAVR between 2011 and 2014 found that women who underwent transfemoral TAVR had lower in-hospital mortality compared with men (odds ratio: 0.87 [CI, 0.77–1.00]). 7 In contrast to these findings, a study of the National Inpatient Sample database from 2012 to 2015 with 61 239 patients found that women had increased in-hospital mortality following TAVR compared with men (adjusted odds ratio, 1.25 [95% CI, 1.01–1.54]). 6 With regard to long-term mortality, data from the Transcatheter Valve Therapy Registry included 23 652 patients and demonstrated lower 1-year mortality among women (adjusted hazard ratio, 0.73 [95% CI, 0.63–0.85]) compared with men 12 whereas a cohort of 683 patients in Australia who underwent TAVR showed that long-term mortality (up to 10 years) was similar between men and women.…”

Section: Discussionmentioning

confidence: 96%

Sex Differences in the Impact of Aortic Valve Calcium Score on Mortality After Transcatheter Aortic Valve Replacement

Patel

Sabbagh

Johnson

et al. 2022

Circ: Cardiovascular Imaging

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BACKGROUND: Transcatheter aortic valve replacement (TAVR) is now an approved alternative to surgical aortic valve replacement for the treatment of severe aortic stenosis. As the clinical adoption of TAVR expands, it remains important to identify predictors of mortality after TAVR. We aimed to evaluate the impact of sex differences in aortic valve calcium score (AVCS) on long-term mortality following TAVR in a large patient sample. Methods: We included consecutive patients who successfully underwent TAVR for treatment of severe native aortic valve stenosis from June 2010 to May 2021 across all US Mayo Clinic sites with follow-up through July 2021. AVCS values were obtained from preoperative computed tomography of the chest. Additional clinical data were abstracted from medical records. Kaplan-Meier curves and Cox-proportional hazard regression models were employed to evaluate the effect of AVCS on long-term mortality. Results: A total of 2543 patients were evaluated in the final analysis. Forty-one percent were women, median age was 82 years (Q1: 76, Q3: 86), 18.4% received a permanent pacemaker following TAVR, and 88.5% received a balloon expandable valve. We demonstrate an increase in mortality risk with higher AVCS after multivariable adjustment ( P <0.001). When stratified by sex, every 500-unit increase in AVCS was associated with a 7% increase in mortality risk among women (adjusted hazard ratio, 1.07 [95% CI, 1.02–1.12]) but not in men. Conclusions: We demonstrate a notable sex difference in the association between AVCS and long-term mortality in a large TAVR patient sample. This study highlights the potential value of AVCS in preprocedural risk stratification, specifically among women undergoing TAVR. Additional studies are needed to validate this finding.

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“…Our findings augment previous research reporting the importance of parsing the effect of sex and gender on outcomes after TAVI. 39 , 40 …”

Section: Discussionmentioning

confidence: 99%

Quality-of-Life Outcomes After Transcatheter Aortic Valve Implantation in a “Real World” Population: Insights From a Prospective Canadian Database

Lauck

Ding

et al. 2021

CJC Open

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Background Documentation of quality of life (QOL) of patients after transcatheter aortic valve implantation (TAVI) is a Canadian Cardiovascular Society quality indicator. National results have not been reported to date. Methods We conducted an observational cohort study including all TAVI patients, irrespective of surgical risk, treated between January 2016 and June 2019 as documented in the British Columbia TAVI Registry. QOL was measured at baseline, 30 days, and 1 year, using the Kansas City Cardiomyopathy Questionnaire overall score (KCCQ-OS). We used linear regression modelling to examine factors associated with 30-day changes in QOL, logistic regression modelling to identify predictors of sustaining a poor outcome, and Cox regression modelling to ascertain risk estimates of the effect of QOL on 1-year mortality. Results The cohort included 1706 patients (742 women [43.5%]); median age 83 years (interquartile range [IQR]: 77, 86). Median (IQR) baseline KCCQ-OS was 45 (28.2, 67), indicating severe impairment. Patients alive at 1 year (91.3%) reported a mean improvement of 24.1 (95% confidence interval [CI], 22.7-25.6) points in the KCCQ-OS at 30 days, which was sustained at 1 year (25.3; 95% CI, 23.8, 26.8). Older age, lower baseline health status, lower aortic valve gradient, lower hemoglobin, atrial fibrillation, and non-transfemoral access were associated with worse 30-day QOL. At 1 year, 65% of patients had a favorable outcome; additional risk factors for 1-year mortality (8.7%) were male sex, New York Heart Association Class IV, severe pulmonary and renal disease, diabetes, and in-patient status. Conclusions TAVI is associated with significant early improvement in QOL, which is sustained at 1 year. The inclusion of QOL can support treatment decisions and patient-centred evaluation.

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Sex-Specific Differences in Outcome of Transcatheter or Surgical Aortic Valve Replacement

Cited by 28 publications

References 24 publications

Nationwide outcomes of aortic valve replacement for pure aortic regurgitation in Germany 2008–2015

Nationwide outcomes of aortic valve replacement for pure aortic regurgitation in Germany 2008–2015

Sex Differences in the Impact of Aortic Valve Calcium Score on Mortality After Transcatheter Aortic Valve Replacement

Quality-of-Life Outcomes After Transcatheter Aortic Valve Implantation in a “Real World” Population: Insights From a Prospective Canadian Database

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