Sex-Related Differences in Clinical Presentation and Outcome of Transcatheter Aortic Valve Implantation for Severe Aortic Stenosis

被引:161
作者
Hayashida, Kentaro [1 ]
Morice, Marie-Claude [1 ]
Chevalier, Bernard [1 ]
Hovasse, Thomas [1 ]
Romano, Mauro [1 ]
Garot, Philippe [1 ]
Farge, Arnaud [1 ]
Donzeau-Gouge, Patrick [1 ]
Bouvier, Erik [1 ]
Cormier, Bertrand [1 ]
Lefevre, Thierry [1 ]
机构
[1] Inst Cardiovasc Paris Sud, Massy, France
关键词
aortic stenosis; mortality; sex differences; transcatheter aortic valve implantation; Valve Academic Research Consortium; LONG-TERM OUTCOMES; REPLACEMENT; PROSTHESIS; SURGERY; MORTALITY; MISMATCH;
D O I
10.1016/j.jacc.2011.10.877
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objectives The purpose of this study was to clarify the impact of sex-related differences in transcatheter aortic valve implantation (TAVI) for high-risk patients with severe aortic stenosis. Background Although TAVI is becoming a mature technique, the impact of sex differences remains unclear. Methods The TAVI patients were included prospectively in a dedicated database from October 2006. The proportion of women (n = 131) was similar to that of men (n = 129). The Edwards valve (85.4%) and CoreValve (14.6%) were used through the transfemoral (65.0%), subclavian (3.1%), or transapical (31.9%) approach. All events were defined according to Valve Academic Research Consortium criteria. Results Age was similar (83.1 +/- 6.3 years), but women had less coronary and peripheral disease, less previous cardiac surgery, higher ejection fraction, and lower EuroSCORE (European System for Cardiac Operative Risk Evaluation [22.3 +/- 9.0% vs. 26.2 +/- 13.0%, p = 0.005]). Minimal femoral size (7.74 +/- 1.03 mm vs. 8.55 +/- 1.34 mm, p < 0.001), annulus size (20.9 +/- 1.4 vs. 22.9 +/- 1.7 mm, p < 0.001), and valve size (23.9 +/- 1.6 mm vs. 26.3 +/- 1.5 mm, p < 0.001) were smaller in women. Device success was similar (90.8% vs. 88.4%, p = 0.516) despite more frequent iliac complications (9.0% vs. 2.5%, p = 0.030). Residual mean aortic pressure gradient (11.6 +/- 4.9 vs. 10.9 +/- 4.9, p = 0.279) was also similar. The 1-year survival rate was higher for women, 76% (95% confidence interval: 72% to 80%), than for men, 65% (95% confidence interval: 60% to 69%); and male sex (hazard ratio: 1.62, 95% confidence interval: 1.03 to 2.53, p = 0.037) was identified as a predictor of midterm mortality by Cox regression analysis. Conclusions Female sex is associated with better baseline clinical characteristics and improved survival, and is identified as a predictor of midterm survival after TAVI. (J Am Coll Cardiol 2012;59:566-71) (C) 2012 by the American College of Cardiology Foundation
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收藏
页码:566 / 571
页数:6
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