Abstract 13494: Are There Gender Anatomical Annular Disparities and Functional Outcome Following Transcatheter Aortic Valve Replacement?
Background: Pre-operative annular assessment sizing has been considered a critical step for appropriate patient and valve size selection for transcatheter aortic valve replacement (TAVR). Accurate understanding of annular geometry can optimize the patient-valve interaction as assessed by immediate hemodynamic response, aortic regurgitation and residual gradient. Few studies have assessed the gender differences on annular dimensions and functional outcomes.
Objectives: This study sought to compare the supra and infra annular anatomic parameters and the functional outcome according to gender in patients referred to TAVR.
Methods: Patients planned to undergo TAVR were systematically evaluated by transtoracic echocardiogram. The annular geometry components compared included the diameter of the left ventricular outflow track (LVOT), aortic root and ascending aorta. We also compared the incidence of aortic regurgitation, residual mean gradient and the immediate capillary pressure response ([[Unable to Display Character: ▵]] mean change) following the procedure.
Results: The study population comprised 192 women and 181 men (mean age: 84 ± 7 years) who underwent TAVR for symptomatic aortic stenosis. Women were characterized by a lower LVOT (1.9 ± 0.2 vs. 2.0 ± 0.2 cm; p <.01), aortic root (2.9 ± 0.4 vs. 3.3 ± 0.4 cm; p <.01) and ascending aorta (3.8 ± 0.1 vs. 4.6 ± 0.1 cm; p <.01) diameters and aortic valve area (0.6 ± 0.1 vs. 0.7 ± 0.1 cm2; p <.01). As a result, the 23-mm prosthesis size was used more in women than in men (88 vs. 20%; p <.01). The incidence of aortic regurgitation was significantly higher in women (13 vs. 6%; p <0.1) as was the residual mean gradient (13 ± 5 vs. 11 ± 4 mm Hg; p <.01). No immediate hemodynamic response was observed in women in the capillary wedge pressure compared with a statistically significant change in men ([[Unable to Display Character: ▵]] mean change: 1.0 ± 2.0 vs. -12.0 ± 1.4 mm Hg ; p <.01).
Conclusions: The anatomical annular complex in patients undergoing TAVR differs significantly in women compared to men. The patient-valve interaction in women appears to be suboptimal compared to men with higher rates of aortic regurgitation, residual mean gradient and paradoxical immediate increase in the capillary wedge pressure.
- © 2013 by American Heart Association, Inc.