Author + information
- Received August 26, 2019
- Revision received September 12, 2019
- Accepted September 13, 2019
- Published online September 25, 2019.
- Wieneke Vlastra, MD†∗,
- Jaya Chandrasekhar, MBBS, MS§,†∗,
- Bruno García Del Blanco°,
- Didier Tchétché, MD‡,
- Fabio S. de Brito Jr., MD, PhD#,
- Marco Barbanti, MDϕ,
- Ran Kornowski, MDЖ,
- Azeem Latib, MDμ,
- Augusto D’Onofrio, MD, PhDψ,
- Flavio Ribichini, MD, PhDΦ,
- Jan Baan, MD, PhD†,
- Jan G.P. Tijssen, PhD†,
- Raul Morenoθ,
- Nicolas Dumonteil, MD‡,
- Flavio Tarasoutchi#,
- Samantha Sartori, PhD§,
- Paola D’Errigo, MSc∗∗,
- Giuseppe Tarantini, MD, PhDψ,
- Mattia Lunardi, MDϕ,
- Katia Orvin, MDЖ,
- Matteo Pagnesi, MDμ,
- Alberto Berenguerx,
- Thomas Modine, MD##,
- George Dangas, MD, PhD§,
- Roxana Mehran, MD§,
- Jan J. Piek, MD, PhD† and
- Ronak Delewi, MD, PhD†∗ (, )@amsterdamumc
- †Heart Center, Department of Clinical and Experimental Cardiology, University of Amsterdam, Amsterdam UMC, The Netherlands
- §The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- °Department of Cardiology, Vall d'Hebron University Hospital and Research Institute, Universitat Autònoma de Barcelona, Spain
- ‡Clinique Pasteur, Toulouse, France
- #Heart Institute, University of São Paulo Medical School, São Paulo, Brazil
- φDivision of Cardiology, Policlinico-Vittorio Emanuele Hospital, University of Catania, Italy
- ЖCardiology Department, Rabin Medical Center, Petach Tikva, Israel
- μInterventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
- ψDivision of Cardiac Surgery, University of Padova, Italy
- ΦDivision of Cardiology, Department of Medicine, University of Verona, Verona, Italy
- θInterventional Cardiology Department, La Paz University Hospital, Madrid, Spain
- ∗∗National Centre for Global Helath - Istituto Superiore di Sanità, Rome, Italy
- χCardiology Department, Hospital General de Valencia, Valencia, Spain
- ##Centre Hospitalier Universitaire, Lille, France
- ↵∗Correspondence to: Ronak Delewi, MD, PhD Heart Center, Department of cardiology University of Amsterdam, Amsterdam University Medical Center Meibergdreef 9 1105AZ Amsterdam, The Netherlands Telephone: +31-20-5669111 Fax: +31-20-6962609.
Background Transfemoral aortic valve replacement (TAVR) is a guideline-recommended treatment option for patients with severe aortic valve stenosis. Females and males present with different baseline characteristics, which may influence procedural outcomes.
Objectives To evaluate differences between females and males undergoing transfemoral TAVR across the globe during the last decade.
Methods The CENTER collaboration was a global patient level dataset of patients undergoing transfemoral TAVR (N= 12,381) from 2007-2018. In this retrospective analysis we examined differences in baseline patient characteristics, 30-day stroke and mortality and in-hospital outcomes between female and male patients. We also assessed for temporal changes in outcomes and predictors for mortality per gender.
Results We included 58% (n=7,120) female and 42% (n=5,261) male patients. Females had higher prevalence of hypertension and glomerular filtration rate <30ml/min/m2, but lower prevalence of all other traditional cardiovascular comorbidities. Both genders had similar rates of 30-day stroke (2.3% vs 2.5%, p=0.53) and mortality (5.9% vs. 5.5%, p=0.17). In contrast, females had a 50% higher risk of life-threatening or major bleeding (6.7% vs 4.4%, p<0.01). Over the study period mortality rates decreased to a greater extent in males than in females (60% vs 50% reduction, both p<0.001), with no reductions in stroke rates over time.
Conclusions In this global collaboration females and males had similar rates of 30-day mortality and stroke. However, females had higher rates of procedural life-threatening or major bleeding after TAVR. Between 2007 and 2018 mortality rates decreased to a greater extent in males than in females.
- Transfemoral aortic valve implantation
- gender differences
- predictors of 30-day mortality
- outcome differences over time
↵∗ Wieneke Vlastra and Jaya Chandrasekhar contributed equally as first authors to this manuscript
Dr. de Brito Jr is a proctor for Edwards Lifesciences and Medtronic. Dr. Barbanti is consultant for Edwards Lifesciences, and received speaker honoraria from Medtronic and Biotronik. Dr. Latib is a consultant for Medtronic, and has received honoraria from Abbott Vascular. Dr. Baan receives an unrestricted research grant from Edwards Lifesciences. The remaining authors have no relevant disclosures.
Sources of Funding We acknowledge the support from the Netherlands CardioVascular Research Initiative: the Dutch Heart Foundation (CVON 2018-28 & 2012-06 Heart Brain Connection), Dutch Federation of University Medical Centres , the Netherlands Organisation for Health Research and Development and the Royal Netherlands Academy of Sciences.
- Received August 26, 2019.
- Revision received September 12, 2019.
- Accepted September 13, 2019.
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