Sex Disparities in Hemodynamics and Outcomes in Patients Who Underwent Contemporary Transcatheter Aortic Valve Implantation.
Sex Disparities in Hemodynamics and Outcomes in Patients Who Underwent Contemporary Transcatheter Aortic Valve Implantation.
- 2022
Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006
Studies have reported worse outcomes after transcatheter aortic valve implantation (TAVI) in women receiving early generation transcatheter heart valves (THVs). They have smaller aortic annuli, which could result in higher gradients and more patient-prosthesis mismatch (PPM) after TAVI. We investigated the interactions between contemporary THV hemodynamics and outcomes in women who underwent TAVI. We conducted a retrospective, observational study of patients who underwent contemporary TAVI from 2015 to 2020. We compared baseline characteristics, in-hospital outcomes, and hemodynamics according to sex. We then dichotomized women according to aortic annular area (<430 or >=430 mm2). Included were 869 patients who underwent TAVI with the SAPIEN 3 or CoreValve Evolut PRO/PRO+. Most patients with small annuli were female (82.5%). They had nonsignificantly higher mortality (30-day: 1.5% vs 0.6%, p = 0.313; 1-year: 4.1% vs 2.7%, p = 0.265). Those who received self-expanding THVs had lower gradients (8.0 mm Hg vs 13.8 mm Hg, p <0.001), resulting in less moderate PPM (21.2% vs 73.6%, p <0.001), similar severe PPM (19.5% vs 15.3%, p = 0.454), and higher rates of pacemaker implantation (14.4% vs 4.2%, p = 0.009). Women with small annuli who received a balloon-expandable THV had nonsignificantly higher mortality (30-day: 2.1% vs 0.8%, p = 0.631; 1-year: 6.3% vs 1.7%, p = 0.118). In conclusion, women who underwent contemporary TAVI had nonsignificantly higher mortality, which could be due to higher PPM rates. These findings were more pronounced in the subset of women with small annuli, in whom those who received self-expanding THVs demonstrated superior hemodynamics at the cost of increased rates of pacemaker implantation. Copyright © 2022 Elsevier Inc. All rights reserved.
English
0002-9149
10.1016/j.amjcard.2022.03.028 [doi] S0002-9149(22)00336-8 [pii]
*Aortic Valve Stenosis
*Heart Valve Prosthesis
*Transcatheter Aortic Valve Replacement
Aortic Valve Stenosis/et [Etiology]
Aortic Valve Stenosis/su [Surgery]
Aortic Valve/su [Surgery]
Female
Heart Valve Prosthesis/ae [Adverse Effects]
Hemodynamics
Humans
Male
Prosthesis Design
Retrospective Studies
Transcatheter Aortic Valve Replacement/mt [Methods]
Treatment Outcome
MedStar Heart & Vascular Institute
MedStar Washington Hospital Center
Interventional Cardiology Fellowship
Journal Article
Observational Study
Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006
Studies have reported worse outcomes after transcatheter aortic valve implantation (TAVI) in women receiving early generation transcatheter heart valves (THVs). They have smaller aortic annuli, which could result in higher gradients and more patient-prosthesis mismatch (PPM) after TAVI. We investigated the interactions between contemporary THV hemodynamics and outcomes in women who underwent TAVI. We conducted a retrospective, observational study of patients who underwent contemporary TAVI from 2015 to 2020. We compared baseline characteristics, in-hospital outcomes, and hemodynamics according to sex. We then dichotomized women according to aortic annular area (<430 or >=430 mm2). Included were 869 patients who underwent TAVI with the SAPIEN 3 or CoreValve Evolut PRO/PRO+. Most patients with small annuli were female (82.5%). They had nonsignificantly higher mortality (30-day: 1.5% vs 0.6%, p = 0.313; 1-year: 4.1% vs 2.7%, p = 0.265). Those who received self-expanding THVs had lower gradients (8.0 mm Hg vs 13.8 mm Hg, p <0.001), resulting in less moderate PPM (21.2% vs 73.6%, p <0.001), similar severe PPM (19.5% vs 15.3%, p = 0.454), and higher rates of pacemaker implantation (14.4% vs 4.2%, p = 0.009). Women with small annuli who received a balloon-expandable THV had nonsignificantly higher mortality (30-day: 2.1% vs 0.8%, p = 0.631; 1-year: 6.3% vs 1.7%, p = 0.118). In conclusion, women who underwent contemporary TAVI had nonsignificantly higher mortality, which could be due to higher PPM rates. These findings were more pronounced in the subset of women with small annuli, in whom those who received self-expanding THVs demonstrated superior hemodynamics at the cost of increased rates of pacemaker implantation. Copyright © 2022 Elsevier Inc. All rights reserved.
English
0002-9149
10.1016/j.amjcard.2022.03.028 [doi] S0002-9149(22)00336-8 [pii]
*Aortic Valve Stenosis
*Heart Valve Prosthesis
*Transcatheter Aortic Valve Replacement
Aortic Valve Stenosis/et [Etiology]
Aortic Valve Stenosis/su [Surgery]
Aortic Valve/su [Surgery]
Female
Heart Valve Prosthesis/ae [Adverse Effects]
Hemodynamics
Humans
Male
Prosthesis Design
Retrospective Studies
Transcatheter Aortic Valve Replacement/mt [Methods]
Treatment Outcome
MedStar Heart & Vascular Institute
MedStar Washington Hospital Center
Interventional Cardiology Fellowship
Journal Article
Observational Study