Author + information
- Received May 24, 2011
- Revision received October 25, 2011
- Accepted October 27, 2011
- Published online February 7, 2012.
- Kentaro Hayashida, MD, PhD,
- Marie-Claude Morice, MD⁎ (, )
- Bernard Chevalier, MD,
- Thomas Hovasse, MD,
- Mauro Romano, MD,
- Philippe Garot, MD,
- Arnaud Farge, MD,
- Patrick Donzeau-Gouge, MD,
- Erik Bouvier, MD,
- Bertrand Cormier, MD and
- Thierry Lefèvre, MD
- ↵⁎Reprint requests and correspondence:
Dr. Marie-Claude Morice, Institut Hospitalier Jacques Cartier, 6 Avenue du Noyer Lambert, Massy 91300, France
Objectives The purpose of this study was to clarify the impact of sex-related differences in transcatheter aortic valve implantation (TAVI) for high-risk patients with severe aortic stenosis.
Background Although TAVI is becoming a mature technique, the impact of sex differences remains unclear.
Methods The TAVI patients were included prospectively in a dedicated database from October 2006. The proportion of women (n = 131) was similar to that of men (n = 129). The Edwards valve (85.4%) and CoreValve (14.6%) were used through the transfemoral (65.0%), subclavian (3.1%), or transapical (31.9%) approach. All events were defined according to Valve Academic Research Consortium criteria.
Results Age was similar (83.1 ± 6.3 years), but women had less coronary and peripheral disease, less previous cardiac surgery, higher ejection fraction, and lower EuroSCORE (European System for Cardiac Operative Risk Evaluation [22.3 ± 9.0% vs. 26.2 ± 13.0%, p = 0.005]). Minimal femoral size (7.74 ± 1.03 mm vs. 8.55 ± 1.34 mm, p < 0.001), annulus size (20.9 ± 1.4 vs. 22.9 ± 1.7 mm, p < 0.001), and valve size (23.9 ± 1.6 mm vs. 26.3 ± 1.5 mm, p < 0.001) were smaller in women. Device success was similar (90.8% vs. 88.4%, p = 0.516) despite more frequent iliac complications (9.0% vs. 2.5%, p = 0.030). Residual mean aortic pressure gradient (11.6 ± 4.9 vs. 10.9 ± 4.9, p = 0.279) was also similar. The 1-year survival rate was higher for women, 76% (95% confidence interval: 72% to 80%), than for men, 65% (95% confidence interval: 60% to 69%); and male sex (hazard ratio: 1.62, 95% confidence interval: 1.03 to 2.53, p = 0.037) was identified as a predictor of midterm mortality by Cox regression analysis.
Conclusions Female sex is associated with better baseline clinical characteristics and improved survival, and is identified as a predictor of midterm survival after TAVI.
- aortic stenosis
- sex differences
- transcatheter aortic valve implantation
- Valve Academic Research Consortium
Dr. Hayashida is supported by an educational bursary from Banyu Life Science Foundation International, Tokyo, Japan. Dr. Chevalier is a consultant for Abbott Vascular. Drs. Romano and Lefèvre are proctors for Edwards TAVI. All other authors have reported they have no relationships relevant to the contents of this paper to disclose.
- Received May 24, 2011.
- Revision received October 25, 2011.
- Accepted October 27, 2011.
- American College of Cardiology Foundation