Sex-related differences in outcomes after transcatheter or surgical aortic valve replacement in patients with severe aortic stenosis: Insights from the PARTNER Trial (Placement of Aortic Transcatheter Valve). 

 -  2014 
<br/><br/>Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007 
<br/><br/> BACKGROUND: The PARTNER (Placement of Aortic Transcatheter Valve) trial demonstrated similar 2-year survival with SAVR or TAVR for high-risk patients, but sex-specific outcomes are unknown.  CONCLUSIONS: In this retrospective subanalysis of high-risk, symptomatic aortic stenosis patients in the PARTNER trial, female subjects had lower late mortality with TAVR versus SAVR. This was especially true among patients suitable for transfemoral access and suggests that TAVR may be preferred over surgery for high-risk female patients. A randomized, controlled trial conducted specifically in female patients is necessary to properly study differences in mortality between treatment modalities. (THE PARTNER TRIAL: Placement of AoRTic TraNscathetER Valve Trial; NCT00530894). Copyright  2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.  METHODS: In all, 699 patients (300 female) were randomly assigned 1:1 to either SAVR or TAVR with a balloon expandable pericardial tissue valve. Baseline characteristics and 2-year outcomes of TAVR versus SAVR were compared among males and females.  OBJECTIVES: This study sought to examine sex-specific differences in outcomes after surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR) in high-risk patients with severe aortic stenosis.  RESULTS: Baseline characteristics differed between the sexes. Despite higher Society of Thoracic Surgeons mortality risk scores (11.9 vs. 11.6; p = 0.05), female patients had lower prevalence of coronary artery disease (64.4% vs. 83.7%), prior coronary artery bypass graft surgery (19.8% vs. 61.2%), peripheral vascular disease (36.4% vs. 46.9%), diabetes mellitus (35.6% vs. 45.6%), and elevated creatinine (11.7% vs. 23.9%). Among female patients, procedural mortality trended lower with TAVR versus SAVR (6.8% vs. 13.1%; p = 0.07) and was maintained throughout follow-up (hazard ratio [HR]: 0.67; 95% confidence interval [CI]: 0.44 to 1.00; p = 0.049), driven by the transfemoral arm (HR: 0.55; 95% CI: 0.32 to 0.93; p = 0.02). Among male patients, although procedural mortality was lower with TAVR (6% vs. 12.1%; p = 0.03), there was no overall survival benefit (HR: 1.15; 95% CI: 0.82 to 1.61; p = 0.42). 
<br/><br/><br/>English 
<br/><br/><label>ISSN: </label>0735-1097 
<br/><br/><label>Subjects--Topical Terms: </label><br/>*Aortic Valve Stenosis/su [Surgery]<br/>*Cardiac Catheterization/mt [Methods]<br/>*Heart Valve Prosthesis Implantation/mt [Methods]<br/>*Postoperative Complications/ep [Epidemiology]<br/>Aged, 80 and over<br/>Aortic Valve Stenosis/di [Diagnosis]<br/>Aortic Valve Stenosis/ep [Epidemiology]<br/>Echocardiography<br/>Female<br/>Follow-Up Studies<br/>Hospital Mortality/td [Trends]<br/>Humans<br/>Incidence<br/>Male<br/>Retrospective Studies<br/>Risk Factors<br/>Severity of Illness Index<br/>Sex Distribution<br/>Sex Factors<br/>Survival Rate/td [Trends]<br/>Treatment Outcome<br/>United States/ep [Epidemiology]
<br/><br/><label>Subjects--Geographic Terms: </label><br/>MedStar Heart & Vascular Institute
<br/><br/><label>Index Terms--Function: </label><br/>Journal Article<br/>Multicenter Study<br/>Randomized Controlled Trial<br/>Research Support, Non-U.S. Gov't