JACC: Cardiovascular Interventions
Long-Term Outcomes With Transcatheter Aortic Valve Replacement in Women Compared With MenEvidence From a Meta-Analysis
Author + information
- Marwan Saad, MD, PhDa,
- Ramez Nairooz, MDb,
- Naga Venkata K. Pothineni, MDa,
- Ahmed Almomani, MDa,
- Swathi Kovelamudi, MDa,
- Partha Sardar, MDc,
- Marcelo Katz, MD, PhDd,
- Mohamed Abdel-Wahab, MDe,
- Sripal Bangalore, MD, MHAf,
- Neal S. Kleiman, MDg,
- Peter C. Block, MDh and
- J. Dawn Abbott, MDi,∗ (jabbott{at}lifespan.org)
- aDivision of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
- bDivision of Cardiology, University of Southern California, Los Angeles, California
- cDivision of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah
- dHospital Israelita Albert Einstein, Sao Paulo, Brazil
- eHeart Center, Segeberger Kliniken (Academic Teaching Hospital of the Universities of Kiel, Lübeck, and Hamburg), Bad Segeberg, Germany
- fDivision of Cardiovascular Medicine, New York University School of Medicine, New York, New York
- gHouston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
- hDivision of Cardiovascular Medicine, Emory University School of Medicine, Atlanta, Georgia
- iDivision of Cardiovascular Medicine, Warren Alpert School of Medicine at Brown University, Providence, Rhode Island
- ↵∗Address for correspondence:
Dr. J. Dawn Abbott, Division of Cardiovascular Medicine, Warren Alpert School of Medicine at Brown University, Rhode Island Hospital, 593 Eddy Street, 814 APC, Providence, Rhode Island 02905.
Graphical abstract
Abstract
Objectives This study sought to examine long-term outcomes with transcatheter aortic valve replacement (TAVR) in women versus men.
Background TAVR is commonly performed in women. Previous studies have shown conflicting results with respect to sex differences in outcomes with TAVR. In addition, short-term outcomes have primarily been reported.
Methods Electronic search was performed until March 2017 for studies reporting outcomes with TAVR in women versus men. Random effects DerSimonian-Laird risk ratios were calculated. Outcomes included all-cause mortality and major cardiovascular events at short- (30 days) and long-term (>1 year) follow-up.
Results Seventeen studies (8 TAVR registries; 47,188 patients; 49.4% women) were analyzed. Women were older but exhibited fewer comorbidities. At 30 days, women had more bleeding (p < 0.001), vascular complications (p < 0.001), and stroke/transient ischemic attack (p = 0.02), without difference in all-cause (p = 0.19) or cardiovascular mortality (p = 0.91) compared with men. However, female sex was associated with lower all-cause mortality at 1 year (risk ratio: 0.85; 95% confidence interval: 0.79 to 0.91; p < 0.001), and longest available follow-up (mean 3.28 ± 1.04 years; risk ratio: 0.86; 95% confidence interval: 0.81 to 0.92; p < 0.001), potentially caused by less moderate/severe aortic insufficiency (p = 0.001), and lower cardiovascular mortality (p = 0.009). The female survival advantage remained consistent across multiple secondary analyses. The risk of stroke, moderate/severe aortic insufficiency, and all-cause mortality seemed to vary based on the type of valve used; however, without significant subgroup interactions.
Conclusions Despite a higher upfront risk of complications, women derive a better long-term survival after TAVR compared with men.
Footnotes
Dr. Abdel-Wahab is a proctor for Boston Scientific; has received institutional research grants from Biotronik and St. Jude Medical; and has received speaker fees from Medtronic and Edwards Lifesciences. Dr. Abbott is a research consultant for Pfizer and Recor. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 29, 2017.
- Revision received July 24, 2017.
- Accepted August 2, 2017.
- 2018 American College of Cardiology Foundation
