Author + information
- Susheel K. Kodali,
- Mathew Williams,
- Karin Humphries,
- David Cohen,
- Vuyisile Nkomo,
- Neil Weissman,
- Vinod Thourani,
- Lars Svensson,
- E. Murat Tuzcu,
- Thomas C. McAndrew,
- Martin B. Leon,
- D. Craig Miller and
- Ajay Kirtane
The PARTNER trial demonstrated that transcatheter aortic valve replacement (TAVR) is an effective therapy for patients with severe aortic stenosis (AS) who are at high surgical risk. Several recent studies have demonstrated sex specific differences after TAVR.
All patients (n=2585) who underwent TAVR with the Edwards Sapien Valve during either the randomized or non–randomized continued access phase of the PARTNER trial were included in this analysis. Sex specific differences in baseline characteristics and outcomes at 2 years were compared. Outcomes were additionally assessed based upon the access strategy (transfemoral [TF, n=1432] and transapical [TA, n=1079]).
Although mean age (84.9 vs 84.1, p=0.003) and STS score (11.9 vs 11.1, p<0.0001) were higher in female patients (n=1231, 48%), the prevalence of comorbidities was significantly lower: coronary artery disease (67.5% vs 87.6%), prior CABG (24.4% vs 59.3%), peripheral vascular disease (39.4% vs 46.4%), and chronic kidney disease (12.6% vs 20.6%) [p<0.001 for all]. There were no significant differences in procedural mortality between female patients and male patients in either the pooled (6.4% vs 6.5%, p=0.97), TF (4.4% vs 4.6%, p=0.86), or TA (8.7% vs 9.3%, p=0.70) cohorts. Procedural stroke was similar between female patients and male patients (pooled: 3.7% vs 3.0%, p=0.38; TF: 4.3% vs 3.6%, p=0.53; TA: 3.0% vs 2.1%, p=0.37). Female patients undergoing TAVR had improved one (17.6 vs 24.3, p=0.0005) and two year survival (29.6 vs 35.3, p=0.002) compared to male patients. In a multivariate model, male sex was a significant predictor of late mortality [HR 1.50, p<0.0001]; this was consistent in both TF [HR 1.32, p=0.02] and TA [HR 1.68, p<0.0001] patients.
Despite similar procedural results, female patients had improved long term outcomes after TAVR compared to male patients. While this is partially explained by a lesser degree of comorbidities, sex remained an independent correlate of late outcomes among patients undergoing
West, Room 2009
Monday, March 11, 2013, 8:15 a.m.–8:25 a.m.
Session Title: Transcatheter Aortic Valve Replacement (TAVR) I: Evolving Data
Abstract Category: 49. TCT@ACC–i2: Aortic Valve Disease
Presentation Number: 2910–3
- 2013 American College of Cardiology Foundation