One-Year Survival Better in Women Than Men After TAVI


PARIS – Although female sex is a risk factor for worse outcomes after conventional cardiac surgery, the opposite appears to be true following transcatheter aortic valve implantation.

Among 260 consecutive patients undergoing TAVI for severe aortic stenosis, female sex was linked with significantly better 1-year survival (76% vs. 65%).

The study, described as the first analysis of sex difference with this emerging technique, also identified female sex as an independent predictor of long-term survival, Dr. Kentaro Hayashida and his colleagues reported at the congress.

The increased survival rate in women treated with TAVI may represent a paradox in the cardiovascular disease gender gap.

“Surgical aortic valve replacement in female patients is technically demanding because of their smaller stature and body surface area, higher body mass index, and smaller aortic root,” Dr. Hayashida of the Institut Cardiovasculaire Paris-Sud (ICPS) in Massy, France, said in an interview. “In our study cohort, TAVI was performed with a similar device success rate, compared to males, because of the procedural feasibility inherent in this novel technique.”

TAVI was successfully achieved in 91% of women and 88.4% of men, a nonsignificant difference. Similarly, no significant sex differences were observed for 30-day mortality (12% for women and 18% for men).

Longer life expectancy and early detection of aortic stenosis in women may, in part, have contributed to their improved survival, coauthor and colleague Dr. Philippe Garot said. He pointed out that despite both sexes having made gains in cardiovascular disease mortality from 1950 to 1999, an 80-year-old man in France can expect to live 8.3 more years, compared with 10.5 additional years for an 80-year-old French woman.

The average age at the time of surgery was 83 years in both study groups.

At baseline, women had a significantly lower logistic EuroSCORE (European System for Cardiac Operative Risk Evaluation, 22% vs. 26%), higher left ventricular ejection fraction (54% vs. 47%) and less coronary artery disease (49% vs. 79%), peripheral artery disease (27% vs. 40%), and previous cardiac surgery (14% vs. 26.4%) than did men.

Women, however, also had a significantly smaller femoral artery size (7.74 vs. 8.55 mm), annulus size (20.9 vs. 22.9 mm), and valve size (23.9 vs. 26.3 mm) than did men, Dr. Garot said.

In a multivariate analysis, male sex was identified as an independent predictor of long-term mortality (odds ratio, 1.80), the authors reported. Other significant risk factors were previous cardiac surgery (OR, 2.3), postprocedural aortic regurgitation (OR, 2.3), transfusion of four or more units (OR, 2.5), acute kidney injury (OR, 6.9), and conversion to open surgery (OR, 5.1).

Notably, vascular complications were not associated with mortality in the study, Dr. Garot said.

Data were prospectively collected on 131 women and 129 men with severe aortic stenosis who were treated at the ICPS from September 2006 through December 2010. TAVI was performed using the Edwards Sapien or Sapien XT valves (85%) or the third-generation CoreValve Revalving system (15%), with 65% of valves placed via the transfemoral approach.

Dr. Hayashida and his coauthors report no conflicts.

To see an interview with Dr. Garot, scan this QR code using your smartphone.

Longer life expectancy may partially explain the increased TAVI survival in women.

Source DR. GAROT

Recommended Reading

Continuous Glucose Monitor Accurate Post-Cardiac Surgery
MDedge Cardiology
Door Widening For Potential TAVI Candidates
MDedge Cardiology
CoreValve Remains Durable 3 Years Post TAVI
MDedge Cardiology
Genes Play Bigger Role in MI Than in Stroke
MDedge Cardiology
'Cool-It' Cardiac Arrest Protocol Curbs Neurologic Damage
MDedge Cardiology