Gender differences after transcatheter aortic valve replacement (TAVR): Insights from the italian clinical service project

Andrea Denegri, Michele Romano, Anna Sonia Petronio, Marco Angelillis, Cristina Giannini, Claudia Fiorina, Luca Branca, Marco Barbanti, Giuliano Costa, Nedy Brambilla, Valentina Mantovani, Matteo Montorfano, Luca Ferri, Giuseppe Bruschi, Bruno Merlanti, Bernhard Reimers, Carlo Pivato, Arnaldo Poli, Carmine Musto, Massimo FineschiDiego Maffeo, Carlo Trani, Flavio Airoldi, Corrado Lettieri

Research output: Contribution to journalArticlepeer-review

Abstract

Background: TAVR is a safe alternative to surgical aortic valve replacement (SAVR); how-ever, sex-related differences are still debated. This research aimed to examine gender differences in a real-world transcatheter aortic valve replacement (TAVR) cohort. Methods: All-comer aor-tic stenosis (AS) patients undergoing TAVR with a Medtronic valve across 19 Italian sites were prospectively included in the Italian Clinical Service Project (NCT01007474) between 2007 and 2019. The primary endpoint was 1-year mortality. We also investigated 3-year mortality, and ischemic and hemorrhagic endpoints, and we performed a propensity score matching to assemble patients with similar baseline characteristics. Results: Out of 3821 patients, 2149 (56.2%) women were en-rolled. Compared with men, women were older (83 ± 6 vs. 81 ± 6 years, p < 0.001), more likely to present severe renal impairment (GFR ≤ 30 mL/min, 26.3% vs. 16.3%, p < 0.001) but had less previous cardiovascular events (all p < 0.001), with a higher mean Society of Thoracic Surgeons (STS) score (7.8% ± 7.1% vs. 7.2 ± 7.5, p < 0.001) and a greater mean aortic gradient (52.4 ± 15.3 vs. 47.3 ± 12.8 mmHg, p < 0.001). Transfemoral TAVR was performed more frequently in women (87.2% vs. 82.1%, p < 0.001), with a higher rate of major vascular complications and life-threatening bleeding (3.9% vs. 2.4%, p = 0.012 and 2.5% vs. 1.4%, p = 0.024). One-year mortality differed between female and male (11.5% vs. 15.0%, p = 0.002), and this difference persisted after adjustment for sig-nificant confounding variables (Adj.HR1yr 1.47, 95%IC 1.18–1.82, p < 0.001). Three-year mortality was also significantly lower in women compared with men (19.8% vs. 24.9%, p < 0.001) even after adjustment for age, STS score, eGFR, diabetes and severe COPD (Adj.HR3yr 1.42, 95%IC 1.21–1.68, p < 0.001). These results were confirmed in 689 pairs after propensity score matching. Conclusion: Despite higher rates of peri-procedural complications, women presented better survival than men. This better adaptive response to TAVR may be driven by sex-specific factors.

Original languageEnglish
Article number114
JournalJournal of Cardiovascular Development and Disease
Volume8
Issue number9
DOIs
Publication statusPublished - Sep 2021

Keywords

  • Aortic stenosis
  • Corevalve
  • CV-outcome
  • Evolut Pro
  • Evolut R
  • Gender differences
  • Medtronic
  • Mortality
  • Sex differences
  • TAVR
  • Women

ASJC Scopus subject areas

  • Pharmacology, Toxicology and Pharmaceutics(all)
  • Pharmacology (medical)

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