Abstract 13500: Gender Comorbidities and Outcome Disparities in Transcatheter Aortic Valve Replacement. A Novel Gender Gap?
Background: Although female gender comprises the majority of patients referred to transcatheter aortic valve replacement (TAVR), few studies have systematically analyzed the gender comorbidities comparison and the independent effect of females on outcomes.
Objectives: This study compares the prevalence of comorbidities and the short- and intermediate-term outcomes according to gender in patients referred to TAVR.
Methods: TAVR patients were stratified according to gender. We compared the prevalence of risk factors, in-hospital outcomes, short-term (30 days) and mid-term (1 year) all-cause mortality according to the Valve Academic Research Consortium (VARC) criteria.The independent effect of gender on mortality was assessed through a multivariate adjustment at 1 year.
Results: The study population comprised 373 consecutive patients (women: n=192 and men: n=181) who underwent TAVR for symptomatic aortic stenosis. Women were characterized by a lower prevalence of comorbidities: chronic renal insufficiency (49% vs. 65%, p <.01), prior myocardial infarction (11% vs. 19%; p=.03), prior coronary bypass surgery (16% vs. 49%; p <.01) and left ventricular ejection fraction <30% (10% vs.17%; p=.04) and higher STS score (11 ± 5 vs. 10 ± 5, p <.01). Women had more procedural and in-hospital complications: conversion to general anesthesia (24% vs. 14%; p <.04), sustained arrhythmias (6% vs. 1%, p <.02), VARC vascular complication (16% vs. 6%, p <.01), transfusion (54% vs. 42%;p <.03) and a trend toward higher rates of VARC in-hospital cardiac death (10.9% vs. 5.5%; p=.05). However, the 30-day and 1-year mortality were not different in females compared to males (10.4% vs. 6.6%; p=.20), (20.8% vs. 20.4%; p=.93), respectively. After multivariate adjustment, female gender was not independently associated with 1-year all-cause mortality.
Conclusions: Although females undergoing TAVR exhibited less comorbidities and prognostic factors, the incidence of procedural and in-hospital adverse events was higher than in males. However, the risk-adjusted analysis identified that female gender is not an independent predictor of mortality at 1 year.
- © 2013 by American Heart Association, Inc.