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Circ Cardiovasc Qual Outcomes. 2019 Mar;12(3):e005363. doi: 10.1161/CIRCOUTCOMES.118.005363.

Sex-Specific Determinants of Outcomes After Transcatheter Aortic Valve Replacement.

Author information

1
Division of Cardiology (M.P., N.P., G.M.), McGill University Health Centre, Montreal, QC, Canada.
2
Division of Cardiac Surgery (K.L.), McGill University Health Centre, Montreal, QC, Canada.
3
Department of Cardiac Surgery (L.P.P.), Institut de Cardiologie de Montréal, Université de Montréal, QC, Canada.
4
Division of Cardiology (A.W.A.), Institut de Cardiologie de Montréal, Université de Montréal, QC, Canada.
5
Centre for Heart Valve Innovation, St Paul's Hospital, University of Vancouver, BC (S.L., J.G.W.).
6
Division of Cardiology (J.J.P.), Beth Israel Deaconess Medical Center, Harvard University, Boston, MA.
7
Division of Gerontology (D.H.K.), Beth Israel Deaconess Medical Center, Harvard University, Boston, MA.
8
Division of Cardiology, Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Massy, France (T.L.).
9
Division of Cardiology, University of Ottawa Heart Institute, ON, Canada (M.L.).
10
Division of Cardiac Surgery, Hamilton Health Sciences, Population Health Research Institute, McMaster University, ON, Canada (A.L.).
11
Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, ON, Canada (M.D.P.).
12
Section of Cardiac Surgery, St Boniface Hospital, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada (R.C.A.).
13
Division of Cardiac Surgery, Centre Hospitalier de l'Université de Montréal, Centre de Recherche du CHUM, QC, Canada (N.N.).
14
Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Montreal, QC, Canada (A.T., J.A.).
15
Division of Cardiology, Jewish General Hospital, McGill University, Montreal, QC, Canada (J.A.).

Abstract

Background Women account for a large proportion of patients treated with transcatheter aortic valve replacement, yet there remain conflicting reports about the effect of sex on outcomes. Moreover, the sex-specific prevalence and prognostic impact of frailty has not been systematically studied in the context of transcatheter aortic valve replacement. Methods and Results A preplanned analysis of the FRAILTY-AVR study (Frailty Aortic Valve Replacement) was performed to analyze the determinants of outcomes in older women and men undergoing transcatheter aortic valve replacement. FRAILTY-AVR was a multinational, prospective, observational cohort assembled at 14 institutions in North America and Europe from 2012 to 2017. Multivariable logistic regression models were stratified by sex and adjusted for covariates. Interaction between sex and each of these covariates was assessed. The primary outcome was 12-month mortality, and the secondary outcome was 1-month composite mortality or major morbidity. The cohort consisted of 340 women and 419 men. Women were older and had higher predicted risk of mortality. Women were more likely to have physical frailty traits, but not cognitive or psychosocial frailty traits, and global indices of frailty were similarly associated with adverse events regardless of sex. Women were more likely to require discharge to a rehabilitation facility, particularly those with physical frailty at baseline, although their functional status was similar to men at 12 months. The risk of 1-month mortality or major morbidity was greater in women, particularly those treated with larger prostheses. The risk of 12-month mortality was not greater in women, with the exception of those with pulmonary hypertension, in whom, there was a significant interaction for increased mortality. Conclusions The present study highlights sex-specific differences in older adults undergoing transcatheter aortic valve replacement and draws attention to the impact of physical frailty in women and their potential risk associated with oversized prostheses and pulmonary hypertension.

KEYWORDS:

female; frailty; morbidity; mortality; transcatheter aortic valve replacement

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