Sex-specific differences in outcomes of transcatheter aortic-valve implantation (TAVI) - 06/01/20
Résumé |
Introduction |
Differences in baseline characteristics and anatomy between female and male patients with aortic-valve stenosis may influence outcomes after TAVI. Female gender has been linked to increased risk of periprocedural adverse events which contrasts with paradoxically more favorable long-term outcomes.
Purpose |
To compare perioperative outcomes and 1-year mortality after TAVI in women versus men.
Methods |
Our retrospective monocentric study included 652 consecutive patients (343 women, 52.6%) with severe, symptomatic aortic stenosis who underwent TAVI from January 2010 to July 2017.
Results |
Women were likely to be older with lower rate of known coronaropathy, peripheral arteriopathy and past cardiac surgery. The 30-day mortality was not significantly different between women (7.3%) and men (7.4%) group, P=0.940. During the postoperative course, VARC-2 major vascular complications (15.7% in women group versus 14.2% in men group, P=0.592) and major bleeding composite criteria (BARC type 3b, 3c and 5) (17.5% versus 17.2%, P=0.909) did not significantly differ between two groups. The incidence of 1-year all-cause mortality was 16.3% (n=56) in women and 23.9% (n=74) in men group, P=0.015. After multivariate analysis, the only independent predictors of 1-year mortality were acute heart failure at admission (adjusted HR 1.83, 95% CI [1.23 to 2.72], P=0.003) and femoral access (adjusted HR 0.48, 95% CI [0.32 to 0.70], P<0.0001) but not female gender (adjusted HR 0.78, 95% CI [0.53 to 1.16], P=0.217). Finally, 30-day and 1-year all-cause mortality in women group continue to decrease in recent implantation period (2015 to 2017): 5.1% versus 9.8%, P=0.068 and 10.3% versus 23.1%, P=0.001, respectively.
Conclusions |
The 1-year all-cause mortality was lower in women than men after TAVI, with similar perioperative outcomes. After multivariate analysis, initial acute heart failure and femoral access were independent predictors of 1-year mortality but not gender.
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Vol 12 - N° 1
P. 89-90 - janvier 2020 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.