Time course of the survival advantage of transcatheter over surgical aortic valve replacement: Interplay between sex and patient risk profile

Daisuke Ueshima; Giulia Masiero; Alessandro Schiavo; Mostafa Rabea Abdelhaleem Badawy; Chiara Fraccaro; Massimo Napodano; Sorin J Brener; Giuseppe Tarantini

doi:10.1002/ccd.28124

Time course of the survival advantage of transcatheter over surgical aortic valve replacement: Interplay between sex and patient risk profile

Catheter Cardiovasc Interv. 2019 Nov 1;94(5):746-752. doi: 10.1002/ccd.28124. Epub 2019 Feb 28.

Authors

Daisuke Ueshima¹, Giulia Masiero¹, Alessandro Schiavo¹, Mostafa Rabea Abdelhaleem Badawy^{1

2}, Chiara Fraccaro¹, Massimo Napodano¹, Sorin J Brener³, Giuseppe Tarantini¹

Affiliations

¹ Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy.
² Department of Cardiology, Faculty of Medicine, Minia University, Minya, Egypt.
³ Department of Medicine, Cardiac Catheterization Laboratory, New York Methodist Hospital, New York, New York.

PMID: 30821116
DOI: 10.1002/ccd.28124

Abstract

Objectives: The aim of this study was to explore the time course of survival advantage of TAVR over SAVR as function of the patients' risk and sex.

Background: Women have been reported to have better survival than men undergoing transcatheter aortic valve replacement (TAVR). However, scant data on the sex-based survival benefit of TAVR over surgical aortic valve replacement (SAVR) are available.

Methods: A systematic review of studies reporting clinical outcomes of men and women undergoing TAVR or SAVR was performed. Studies were divided into two groups according to average patient's risk score and the interplay of surgical risk and sex on outcomes were analyzed.

Results: Eight studies involving 6,596 women and 7,204 men patients were extracted. Unlike mens, women patients had survival advantage from TAVR over SAVR that became substantial at 1 year from index procedure and persisted at 2-year of follow-up. Moreover, this sex-based TAVR survival advantage was mainly observed in higher surgical risk patients. Men showed a significantly lower rate of residual paravalvular leak after SAVR.

Conclusions: Women patients had a selective mortality benefit from TAVR compared to SAVR. This sex-based TAVR benefit was mainly observed in high surgical risk patients beyond 1 year from procedure.

Keywords: aortic valve disease; gender, outcomes/studies; surgery, valvular; transcatheter valve implantation.

Publication types

Systematic Review

MeSH terms

Aged
Aged, 80 and over
Aortic Valve / diagnostic imaging
Aortic Valve / physiopathology
Aortic Valve / surgery*
Aortic Valve Stenosis / diagnostic imaging
Aortic Valve Stenosis / mortality
Aortic Valve Stenosis / physiopathology
Aortic Valve Stenosis / surgery*
Female
Heart Valve Prosthesis Implantation* / adverse effects
Heart Valve Prosthesis Implantation* / instrumentation
Heart Valve Prosthesis Implantation* / mortality
Humans
Male
Risk Assessment
Risk Factors
Sex Factors
Time Factors
Transcatheter Aortic Valve Replacement* / adverse effects
Transcatheter Aortic Valve Replacement* / instrumentation
Transcatheter Aortic Valve Replacement* / mortality
Treatment Outcome