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Transcatheter Aortic Valve Replacement (TAVR) has undergone significant procedural refinement in last few years and has become standard treatment in various subgroups of patients with aortic stenosis. Previous meta-analysis have reported differential rates of complications in men and women, however large scale national data exploring gender differences appears sparse.
We analyzed HCUP’s Nationwide Inpatient Sample database from 2012-2014 using SAS and identified patients who underwent TAVR (ICD-9-CM procedural codes 35.05 and 35.06). Complications were identified using previously published ICD-9 codes and patient safety indicators. Hierarchical two level logistic models were used to evaluate study outcome of in hospital complications.
Of total 41015 (unweighted 8203) procedures included in our analysis (mean age 81.12 years, 81.3% White) 19560 procedures were on female patients. Univariate analysis revealed significantly higher rates of complications in females including any complications (36.94 % vs 32.18%, p<0.0001), vascular complications (8.92 % vs 6.22%, p<0.0001) and cardiac complications (21.4% vs 19.3%, p<0.0001, Figure 1a). After adjusting for confounders, gender was an independent predictor of higher odds in females for these complications (Figure 1b). Interestingly, complications related to device/prosthesis were lower for women (3.38% vs 2.4%, p<0.0001).
Women have higher rates of immediate post-TAVR cardiac and vascular complications which may be related to smaller aortic annuli and femoral diameters. This may further explain lower rates of device/prosthesis associated complications in women due to less para-valvular regurgitation and less prosthesis-patient mismatch. Our study suggests, novel gender based sizing references utilizing advanced imaging techniques to be used to minimize the associated complications.
STRUCTURAL: Valvular Disease: Aortic