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Ann Thorac Surg. 2015 Mar;99(3):809-16. doi: 10.1016/j.athoracsur.2014.09.089. Epub 2015 Jan 27.

Effect of gender after transcatheter aortic valve implantation: a meta-analysis.

Author information

1
Division of Cardiology, Città Della Salute e della Scienza Hospital, Turin, Italy. Electronic address: federico.conrotto@gmail.com.
2
Division of Cardiology, Città Della Salute e della Scienza Hospital, Turin, Italy.
3
Division of Cardiology, Istituto Clinico Humanitas, Milan, Italy.
4
Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
5
Institut Cardiovasculaire Paris Sud, Massy, France.
6
Division of Cardiology, Città Della Salute e della Scienza Hospital, Turin, Italy; Division of Cardiology, Assuit University Hospital, Assuit, Egypt.
7
Department of Surgical Sciences, University of Torino, Turin, Italy.
8
Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy.

Abstract

BACKGROUND:

The effect of gender on patients with aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) remains to be defined.

METHODS:

MEDLINE, Cochrane Library, and Scopus databases were searched for articles describing sex differences in baseline characteristics, procedures, and outcomes. All-cause death at follow-up of at least 1 year was the primary end point, and the independent effect of female gender was evaluated with pooled analysis using a random-effect model and with meta-regression.

RESULTS:

Six studies with 6,645 patients were included, half of them being women presenting with lower European System for Cardiac Operative Risk Evaluation (EuroSCORE) compared with men. At 30 days, more frequent major vascular complications and major and life-threatening bleeding occurred in women, with lower rates of moderate to severe aortic regurgitation, whereas 30-day mortality was similar. After a median follow-up of 365 days (range, 365 to 730 days) all-cause mortality was 24.0% in women and 34.0% in men. A pooled analysis of the multivariable approach found female gender was significantly related to a lower risk of death (odds ratio, 0.82; 95% CI, confidence interval, 0.73 to 0.93; I(2) = 0%). A meta-regression analysis showed age, ejection fraction, previous cardiovascular accident, renal insufficiency, and access site did not influence these data.

CONCLUSIONS:

Female patients undergoing TAVI present with a lower burden of comorbidities. The counterbalance between higher rates of vascular complications but lower of valve regurgitation may explain the reduced risk for women after TAVI, independently from baseline features and access site.

[Indexed for MEDLINE]

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