ORLANDO — Women had fewer deaths after transcatheter aortic valve replacement (TAVR) than men, despite near-doubled risk for in-hospital vascular complications, a late-breaking study here suggested.
There were significantly more in-hospital vascular complications among women in the large registry analysis (8.3% versus 4.4% for men, adjusted odds ratio 1.70, 95% CI 1.34-2.14). Trending without reaching significance were their increased risks for major bleeding (8.0% versus 6.0%, OR 1.19, 95% CI 0.99-1.44) and adverse events (19.0% versus 13.8%, OR 1.14, 95% CI 0.99-1.30).
Even so, by 1 year the female group achieved a lower mortality rate (21.3% versus 24.5%, adjusted hazard ratio 0.73, 95% CI 0.63-0.85) and a reduced frequency of death and stroke combined (24.2% versus 26.6%, adjusted HR 0.80, 95% CI 0.70-0.92), according to Jaya Chandrasekhar, MBBS, of New York’s Icahn School of Medicine at Mount Sinai.
“Greater 1-year survival in women may be due to fewer baseline systemic risk factors, higher cover index, successful management of procedural complications and earlier left ventricular regression,” she told the audience at the Society for Cardiovascular Angiography and Interventions (SCAI) annual meeting.
Furthermore, the falling rates of procedural complications throughout the years “may facilitate greater uptake in women as TAVR expands to a lower risk population,” Chandrasekhar suggested.
Female patients were somewhat older than men (82.3 versus 81.7 years), yet were less likely to have atrial fibrillation (38.9% versus 42.7%) and diabetes (35.0% versus 39.5%). On the other hand, women tended to have:
- Higher odds of moderate-to-severe mitral regurgitation (31.5% versus 26.4%)
- More porcelain aorta (7.7% versus 6.0%)
- Worse glomerular filtration rates (mean 61.2 versus 63.32 mL/min)
- Higher STS score (mean 9 versus 8)
Ted E. Feldman, MD, of Evanston Hospital in Evanston, Ill., and past president of SCAI, joined the panel discussion and emphasized that understanding why sex differences occur after TAVR is “essential.” He noted that there is some data to suggest varying responses to pressure overload between men and women.
Another panelist, Steven R. Bailey, MD, of UT Medicine Health Science Center at San Antonio, said he was “struck” that more mitral regurgitation at baseline “did not translate to worse outcomes.” It remains to be seen if women have more symptoms resolved than men, Chandrasekhar agreed, noting a need for echocardiography data in future studies.
The analysis included 23,562 patients who underwent TAVR from 2011 to 2014 and were enrolled in the TVT registry from the Society of Thoracic Surgeons and American College of Cardiology.
Transfemoral TAVR was less common in women (55.0% versus 65.1%). Operators also opted for smaller sheath and device sizes in this group (65.3% of women getting a 23 mm valve size versus 11.6% of men), and a cover index greater than 8% was more common as well (65.7% versus 53.9%)
“We know that non-transfemoral approaches to TAVR are higher-risk,” commented Bonnie Weiner, MD, of Worcester Medical Center in Massachusetts. It is possible that this can be linked to the early complication rate in the study population, she suggested, after which complication rates run more or less “parallel” between men and women.
Chandrasekhar reported no relevant conflicts of interest.
Society for Cardiovascular Angiography and Interventions
Mehran R, et al “Sex based differences in outcomes with transcatheter aortic valve therapy: from the STS/ACC TVT registry” SCAI 2016; Abstract 14816.