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Effect of gender differences on 1-year mortality after transcatheter aortic valve implantation for severe aortic stenosis: results from a multicenter real-world registry

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Abstract

Objectives

The aim of this analysis is to examine the influence of gender differences on the outcome after transcatheter aortic valve implantation (TAVI) from a multicenter real-world registry in Germany (TAVI registry).

Background

The impact of gender differences on the clinical outcome after TAVI was examined in small studies with conflicting results.

Methods

Consecutive patients (n = 1,432) undergoing TAVI in the period between January 2009 and June 2010 in Germany were evaluated. Differences in all-cause mortality were examined with Kaplan–Meier estimates and proportional hazards models.

Results

Women comprised 57.8 % of the cohort. The Edwards Sapien valve (18.5 %) and CoreValve (81.5 %) were used through the transfemoral (87.7 %), subclavian (3.0 %), transapical (8.6 %), or transaortic approach (0.7 %). At baseline, women had higher aortic gradients and were older. Men had more comorbidities: prior myocardial infarction, prior revascularization, prior coronary artery bypass surgery, peripheral arterial vascular disease and chronic obstructive pulmonary disease. Women had more periprocedural vascular complications in comparison to men (25.2 vs. 17.2 %, p < 0.001). There was no significant difference in mortality at 30-day follow-up (7.6 % for women vs. 8.6 % for men, p = 0.55). The adjusted HR for 1-year all-cause mortality favored women, HR 0.75 (95 % CI 0.57–0.98, p = 0.0346) with a mortality rate of 17.3 vs. 23.6 % for men.

Conclusions

Female gender is associated with better 1-year survival after TAVI. These results suggest that TAVI could be the best treatment modality for elderly women with symptomatic severe aortic stenosis.

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Abbreviations

TAVI:

Transcatheter aortic valve implantation

MACCE:

Major adverse cerebral and cardiovascular events

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Acknowledgments

The centers participating in the German Transcatheter Aortic Valve Interventions Registry are reported elsewhere [8]. Drs. Gerckens, Sievert, and Sack worked as proctors for either Medtronic, Inc., or Edwards Lifesciences or both and received speaker’s honoraria. Dr. Sievert is a member of the scientific advisory board for JenaValve Technology, Munich, Germany. Dr. Zahn has received research funding from Medtronic, Inc., and Edwards Lifesciences.

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Authors and Affiliations

  1. Cardiology Department, Coburg Hospital, Internal Medicine Clinic II, Coburg, Germany

    Mohammad A. Sherif & Johannes Brachmann

  2. Cardiology Department, Heart Center Ludwigshafen, Ludwigshafen, Germany

    Ralf Zahn

  3. Cardiology Clinic, Gemeinschaftskrankenhaus, Bonn, Germany

    Ulrich Gerckens

  4. CardioVascular Center Frankfurt, Sankt Katharinen, Frankfurt am Main, Germany

    Horst Sievert

  5. Department of Cardiology, University Hospital of Essen, Essen, Germany

    Holger Eggebrecht

  6. Cardiology Department, Heart Centre Bremen, Bremen, Germany

    Rainer Hambrecht

  7. Cardiology Department, Munich Schwabing Clinic, Munich, Germany

    Stefan Sack

  8. Segeberger Clinics, Cardiovascular Center, Bad Segeberg, Germany

    Gert Richardt

  9. Research Institute for Heart Attack Ludwigshafen (IHF), Ludwigshafen, Germany

    Steffen Schneider & Jochen Senges

Authors
  1. Mohammad A. Sherif
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  2. Ralf Zahn
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  3. Ulrich Gerckens
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  4. Horst Sievert
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  5. Holger Eggebrecht
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  6. Rainer Hambrecht
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  7. Stefan Sack
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  8. Gert Richardt
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  9. Steffen Schneider
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  10. Jochen Senges
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  11. Johannes Brachmann
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Corresponding author

Correspondence to Mohammad A. Sherif.

Additional information

On behalf of the German Transcatheter Aortic Valve Interventions, Registry Investigators.

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Sherif, M.A., Zahn, R., Gerckens, U. et al. Effect of gender differences on 1-year mortality after transcatheter aortic valve implantation for severe aortic stenosis: results from a multicenter real-world registry. Clin Res Cardiol 103, 613–620 (2014). https://doi.org/10.1007/s00392-014-0690-6

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  • DOI: https://doi.org/10.1007/s00392-014-0690-6

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