Gender Differences after Transcatheter Aortic Valve Replacement (TAVR): Insights from the Italian Clinical Service Project
| Autor: | Bernhard Reimers, Bruno Merlanti, Massimo Fineschi, Anna Sonia Petronio, Marco Angelillis, Flavio Airoldi, Michele Romano, Corrado Lettieri, Carmine Musto, Marco Barbanti, Cristina Giannini, Diego Maffeo, Nedy Brambilla, Claudia Fiorina, Arnaldo Poli, Andrea Denegri, Luca Branca, Luca A. Ferri, Valentina Mantovani, Matteo Montorfano, Giuliano Costa, Giuseppe Bruschi, Carlo Andrea Pivato, Carlo Trani |
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| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
sex differences
medicine.medical_specialty Medtronic Corevalve medicine.medical_treatment TAVR Article Aortic valve replacement Valve replacement CV-outcome Internal medicine Diabetes mellitus medicine Clinical endpoint Diseases of the circulatory (Cardiovascular) system Pharmacology (medical) General Pharmacology Toxicology and Pharmaceutics Evolut R Aortic stenosis Evolut Pro Gender differences Mortality Sex differences Women business.industry Confounding aortic stenosis medicine.disease mortality Stenosis gender differences RC666-701 Cohort Propensity score matching Settore MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE Cardiology cardiovascular system women business |
| Zdroj: | Journal of Cardiovascular Development and Disease Volume 8 Issue 9 Journal of Cardiovascular Development and Disease, Vol 8, Iss 114, p 114 (2021) |
| ISSN: | 2308-3425 |
| DOI: | 10.3390/jcdd8090114 |
| Popis: | Background: TAVR is a safe alternative to surgical aortic valve replacement (SAVR) however, sex-related differences are still debated. This research aimed to examine gender differences in a real-world transcatheter aortic valve replacement (TAVR) cohort. Methods: All-comer aortic stenosis (AS) patients undergoing TAVR with a Medtronic valve across 19 Italian sites were prospectively included in the Italian Clinical Service Project (NCT01007474) between 2007 and 2019. The primary endpoint was 1-year mortality. We also investigated 3-year mortality, and ischemic and hemorrhagic endpoints, and we performed a propensity score matching to assemble patients with similar baseline characteristics. Results: Out of 3821 patients, 2149 (56.2%) women were enrolled. Compared with men, women were older (83 ± 6 vs. 81 ± 6 years, p < 0.001), more likely to present severe renal impairment (GFR ≤ 30 mL/min, 26.3% vs. 16.3%, p < 0.001) but had less previous cardiovascular events (all p < 0.001), with a higher mean Society of Thoracic Surgeons (STS) score (7.8% ± 7.1% vs. 7.2 ± 7.5, p < 0.001) and a greater mean aortic gradient (52.4 ± 15.3 vs. 47.3 ± 12.8 mmHg, p < 0.001). Transfemoral TAVR was performed more frequently in women (87.2% vs. 82.1%, p < 0.001), with a higher rate of major vascular complications and life-threatening bleeding (3.9% vs. 2.4%, p = 0.012 and 2.5% vs. 1.4%, p = 0.024). One-year mortality differed between female and male (11.5% vs. 15.0%, p = 0.002), and this difference persisted after adjustment for significant confounding variables (Adj.HR1yr 1.47, 95%IC 1.18–1.82, p < 0.001). Three-year mortality was also significantly lower in women compared with men (19.8% vs. 24.9%, p < 0.001) even after adjustment for age, STS score, eGFR, diabetes and severe COPD (Adj.HR3yr 1.42, 95%IC 1.21–1.68, p < 0.001). These results were confirmed in 689 pairs after propensity score matching. Conclusion: Despite higher rates of peri-procedural complications, women presented better survival than men. This better adaptive response to TAVR may be driven by sex-specific factors. |
| Databáze: | OpenAIRE |
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