Skip to main content

Advertisement

SpringerLink
Log in

Sex-Specific Considerations in Women with Aortic Stenosis and Outcomes After Transcatheter Aortic Valve Replacement

  • Women’s Health (M Wood, Section Editor)
  • Published:
Current Treatment Options in Cardiovascular Medicine Aims and scope Submit manuscript

Abstract

Aortic stenosis (AS) is the most common valvular disease in the elderly and is associated with poor outcomes. Transcatheter aortic valve replacement (TAVR) is an alternative to surgical aortic valve replacement (SAVR) in high-risk patients. Herein, we describe the gender-related differences in baseline characteristics and pathophysiologic response to severe AS, imaging considerations unique to females, and short- and long-term outcomes after TAVR. Women undergoing TAVR are older and frailer, have less cardiovascular comorbidities, smaller femoral artery size, better left ventricular systolic function, hypertrophied and small left ventricles leading to a higher incidence of paradoxical low-flow low-gradient AS, and a greater prevalence of porcelain aorta, smaller aortic annulus size, and lower coronary ostia heights. Imaging and histopathological data also suggests a sex-related myocardial response to pressure overload from AS. Women experience more vascular complications and blood transfusion requirements, serious procedural complications, and a greater incidence of stroke, but have better long-term outcomes than men. Patient-prosthesis mismatch, which is a concern in patients with a small aortic annulus size undergoing SAVR, has not been problematic with TAVR. The aforementioned findings suggest that TAVR may be preferable for women with severe AS. Further studies are warranted to directly compare TAVR with SAVR in women.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. •• Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP 3rd, Fleisher LA, et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2017;70(2):252–89. This is the most recent update of the AHA/ACC Guidelines for management of patients with valvular heart disease.

    Article  PubMed  Google Scholar 

  2. Chandrasekhar J, Dangas G, Yu J, Vemulapalli S, Suchindran S, Vora AN, et al. Sex-based differences in outcomes with transcatheter aortic valve therapy: TVT registry from 2011 to 2014. J Am Coll Cardiol. 2016;68(25):2733–44.

    Article  PubMed  Google Scholar 

  3. •• Saad M, Nairooz R, Pothineni NVK, Almomani A, Kovelamudi S, Sardar P, et al. Long-term outcomes with transcatheter aortic valve replacement in women compared with men: evidence from a meta-analysis. JACC Cardiovasc Interv. 2018;11(1):24–35. Most recent and largest meta-analysis reporting on long term outcomes with TAVR in women compared with men.

    Article  PubMed  Google Scholar 

  4. • O’Connor SA, Morice MC, Gilard M, Leon MB, Webb JG, Dvir D, et al. Revisiting sex equality with transcatheter aortic valve replacement outcomes: a collaborative, patient-level meta-analysis of 11,310 patients. J Am Coll Cardiol. 2015;66(3):221–8. This is one of the largest patient-level meta-analysis published and the authors report on sex-differences in outcomes after TAVR.

    Article  PubMed  Google Scholar 

  5. Kararigas G, Dworatzek E, Petrov G, Summer H, Schulze TM, Baczko I, et al. Sex-dependent regulation of fibrosis and inflammation in human left ventricular remodeling under pressure overload. Eur J Heart Fail. 2014;16(11):1160–7.

    Article  PubMed  CAS  Google Scholar 

  6. Lee JM, Park SJ, Lee SP, Park E, Chang SA, Kim HK, et al. Gender difference in ventricular response to aortic stenosis: insight from cardiovascular magnetic resonance. PLoS One. 2015;10(3):e0121684.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  7. Stangl V, Baldenhofer G, Knebel F, Zhang K, Sanad W, Spethmann S, et al. Impact of gender on three-month outcome and left ventricular remodeling after transfemoral transcatheter aortic valve implantation. Am J Cardiol. 2012;110(6):884–90.

    Article  PubMed  Google Scholar 

  8. Petrov G, Regitz-Zagrosek V, Lehmkuhl E, Krabatsch T, Dunkel A, Dandel M, et al. Regression of myocardial hypertrophy after aortic valve replacement: faster in women? Circulation. 2010;122(11 Suppl):S23–8.

    Article  PubMed  Google Scholar 

  9. Azevedo CF, Nigri M, Higuchi ML, Pomerantzeff PM, Spina GS, Sampaio RO, et al. Prognostic significance of myocardial fibrosis quantification by histopathology and magnetic resonance imaging in patients with severe aortic valve disease. J Am Coll Cardiol. 2010;56(4):278–87.

    Article  PubMed  Google Scholar 

  10. Barone-Rochette G, Pierard S, De Meester de Ravenstein C, Seldrum S, Melchior J, Maes F, et al. Prognostic significance of LGE by CMR in aortic stenosis patients undergoing valve replacement. J Am Coll Cardiol. 2014;64(2):144–54.

    Article  PubMed  Google Scholar 

  11. Dweck MR, Joshi S, Murigu T, Alpendurada F, Jabbour A, Melina G, et al. Midwall fibrosis is an independent predictor of mortality in patients with aortic stenosis. J Am Coll Cardiol. 2011;58(12):1271–9.

    Article  PubMed  Google Scholar 

  12. Milano AD, Faggian G, Dodonov M, Golia G, Tomezzoli A, Bortolotti U, et al. Prognostic value of myocardial fibrosis in patients with severe aortic valve stenosis. J Thorac Cardiovasc Surg. 2012;144(4):830–7.

    Article  PubMed  Google Scholar 

  13. Dobson LE, Fairbairn TA, Musa TA, Uddin A, Mundie CA, Swoboda PP, et al. Sex-related differences in left ventricular remodeling in severe aortic stenosis and reverse remodeling after aortic valve replacement: a cardiovascular magnetic resonance study. Am Heart J. 2016;175:101–11.

    Article  PubMed  Google Scholar 

  14. •• Clavel MA, Burwash IG, Pibarot P. Cardiac imaging for assessing low-gradient severe aortic stenosis. JACC Cardiovasc Imaging. 2017;10(2):185–202. This review article discusses different types of low-gradient aortic stenosis and imaging features that guide diagnosis and treatment.

    Article  PubMed  Google Scholar 

  15. Coutinho T. Arterial stiffness and its clinical implications in women. Can J Cardiol. 2014;30(7):756–64.

    Article  PubMed  Google Scholar 

  16. Dumesnil JG, Pibarot P, Carabello B. Paradoxical low flow and/or low gradient severe aortic stenosis despite preserved left ventricular ejection fraction: implications for diagnosis and treatment. Eur Heart J. 2010;31(3):281–9.

    Article  PubMed  Google Scholar 

  17. Lauten A, Figulla HR, Mollmann H, Holzhey D, Kotting J, Beckmann A, et al. TAVI for low-flow, low-gradient severe aortic stenosis with preserved or reduced ejection fraction: a subgroup analysis from the German Aortic Valve Registry (GARY). EuroIntervention. 2014;10(7):850–9.

    Article  PubMed  Google Scholar 

  18. Hachicha Z, Dumesnil JG, Bogaty P, Pibarot P. Paradoxical low-flow, low-gradient severe aortic stenosis despite preserved ejection fraction is associated with higher afterload and reduced survival. Circulation. 2007;115(22):2856–64.

    Article  PubMed  Google Scholar 

  19. Pai RG, Varadarajan P, Razzouk A. Survival benefit of aortic valve replacement in patients with severe aortic stenosis with low ejection fraction and low gradient with normal ejection fraction. Ann Thorac Surg. 2008;86(6):1781–9.

    Article  PubMed  Google Scholar 

  20. Kamperidis V, van Rosendael PJ, Katsanos S, van der Kley F, Regeer M, Al Amri I, et al. Low gradient severe aortic stenosis with preserved ejection fraction: reclassification of severity by fusion of Doppler and computed tomographic data. Eur Heart J. 2015;36(31):2087–96.

    Article  PubMed  CAS  Google Scholar 

  21. Joint Task Force on the Management of Valvular Heart Disease of the European Society of C, European Association for Cardio-Thoracic S, Vahanian A, Alfieri O, Andreotti F, Antunes MJ, et al. Guidelines on the management of valvular heart disease (version 2012). Eur Heart J. 2012;33(19):2451–96.

    Article  Google Scholar 

  22. Michelena HI, Margaryan E, Miller FA, Eleid M, Maalouf J, Suri R, et al. Inconsistent echocardiographic grading of aortic stenosis: is the left ventricular outflow tract important? Heart. 2013;99(13):921–31.

    Article  PubMed  Google Scholar 

  23. Clavel MA, Pibarot P, Messika-Zeitoun D, Capoulade R, Malouf J, Aggarval S, et al. Impact of aortic valve calcification, as measured by MDCT, on survival in patients with aortic stenosis: results of an international registry study. J Am Coll Cardiol. 2014;64(12):1202–13.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Dulgheru R, Pibarot P, Sengupta PP, Pierard LA, Rosenhek R, Magne J, et al. Multimodality imaging strategies for the assessment of aortic stenosis: viewpoint of the Heart Valve Clinic International Database (HAVEC) group. Circ Cardiovasc Imaging. 2016;9(2):e004352.

    Article  PubMed  Google Scholar 

  25. Aggarwal SR, Clavel MA, Messika-Zeitoun D, Cueff C, Malouf J, Araoz PA, et al. Sex differences in aortic valve calcification measured by multidetector computed tomography in aortic stenosis. Circ Cardiovasc Imaging. 2013;6(1):40–7.

    Article  PubMed  Google Scholar 

  26. Clavel MA, Messika-Zeitoun D, Pibarot P, Aggarwal SR, Malouf J, Araoz PA, et al. The complex nature of discordant severe calcified aortic valve disease grading: new insights from combined Doppler echocardiographic and computed tomographic study. J Am Coll Cardiol. 2013;62(24):2329–38.

    Article  PubMed  CAS  Google Scholar 

  27. Simard L, Cote N, Dagenais F, Mathieu P, Couture C, Trahan S, et al. Sex-related discordance between aortic valve calcification and hemodynamic severity of aortic stenosis: is valvular fibrosis the explanation? Circ Res. 2017;120(4):681–91.

    Article  PubMed  CAS  Google Scholar 

  28. Onorati F, D’Errigo P, Barbanti M, Rosato S, Covello RD, Maraschini A, et al. Different impact of sex on baseline characteristics and major periprocedural outcomes of transcatheter and surgical aortic valve interventions: results of the multicenter Italian OBSERVANT Registry. J Thorac Cardiovasc Surg. 2014;147(5):1529–39.

    Article  PubMed  Google Scholar 

  29. Fuchs C, Mascherbauer J, Rosenhek R, Pernicka E, Klaar U, Scholten C, et al. Gender differences in clinical presentation and surgical outcome of aortic stenosis. Heart. 2010;96(7):539–45.

    Article  PubMed  Google Scholar 

  30. O’Brien SM, Shahian DM, Filardo G, Ferraris VA, Haan CK, Rich JB, et al. The Society of Thoracic Surgeons 2008 cardiac surgery risk models: part 2—isolated valve surgery. Ann Thorac Surg. 2009;88(1 Suppl):S23–42.

    Article  PubMed  Google Scholar 

  31. Walther T, Hamm CW, Schuler G, Berkowitsch A, Kotting J, Mangner N, et al. Perioperative results and complications in 15,964 transcatheter aortic valve replacements: prospective data from the GARY Registry. J Am Coll Cardiol. 2015;65(20):2173–80.

    Article  PubMed  Google Scholar 

  32. Leon MB, Smith CR, Mack MJ, Makkar RR, Svensson LG, Kodali SK, et al. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med. 2016;374(17):1609–20.

    Article  PubMed  CAS  Google Scholar 

  33. Williams M, Kodali SK, Hahn RT, Humphries KH, Nkomo VT, Cohen DJ, et al. Sex-related differences in outcomes after transcatheter or surgical aortic valve replacement in patients with severe aortic stenosis: insights from the PARTNER Trial (Placement of Aortic Transcatheter Valve). J Am Coll Cardiol. 2014;63(15):1522–8.

    Article  PubMed  Google Scholar 

  34. Buja P, Napodano M, Tamburino C, Petronio AS, Ettori F, Santoro G, et al. Comparison of variables in men versus women undergoing transcatheter aortic valve implantation for severe aortic stenosis (from Italian Multicenter CoreValve registry). Am J Cardiol. 2013;111(1):88–93.

    Article  PubMed  Google Scholar 

  35. Holmes DR Jr, Brennan JM, Rumsfeld JS, Dai D, O’Brien SM, Vemulapalli S, et al. Clinical outcomes at 1 year following transcatheter aortic valve replacement. JAMA. 2015;313(10):1019–28.

    Article  PubMed  CAS  Google Scholar 

  36. Humphries KH, Toggweiler S, Rodes-Cabau J, Nombela-Franco L, Dumont E, Wood DA, et al. Sex differences in mortality after transcatheter aortic valve replacement for severe aortic stenosis. J Am Coll Cardiol. 2012;60(10):882–6.

    Article  PubMed  Google Scholar 

  37. Kodali S, Williams MR, Doshi D, Hahn RT, Humphries KH, Nkomo VT, et al. Sex-Specific differences at presentation and outcomes among patients undergoing transcatheter aortic valve replacement: a cohort study. Ann Intern Med. 2016;164(6):377–84.

    Article  PubMed  Google Scholar 

  38. Gaglia MA Jr, Lipinski MJ, Torguson R, Gai J, Ben-Dor I, Bernardo NL, et al. Comparison in men versus women of co-morbidities, complications, and outcomes after transcatheter aortic valve implantation for severe aortic stenosis. Am J Cardiol. 2016;118(11):1692–7.

    Article  PubMed  Google Scholar 

  39. Forrest JK, Adams DH, Popma JJ, Reardon MJ, Deeb GM, Yakubov SJ, et al. Transcatheter aortic valve replacement in women versus men (from the US CoreValve Trials). Am J Cardiol. 2016;118(3):396–402.

    Article  PubMed  Google Scholar 

  40. Tamburino C, Capodanno D, Ramondo A, Petronio AS, Ettori F, Santoro G, et al. Incidence and predictors of early and late mortality after transcatheter aortic valve implantation in 663 patients with severe aortic stenosis. Circulation. 2011;123(3):299–308.

    Article  PubMed  Google Scholar 

  41. Abdel-Wahab M, Zahn R, Horack M, Gerckens U, Schuler G, Sievert H, et al. Aortic regurgitation after transcatheter aortic valve implantation: incidence and early outcome. Results from the German transcatheter aortic valve interventions registry. Heart. 2011;97(11):899–906.

    Article  PubMed  Google Scholar 

  42. Kodali SK, Williams MR, Smith CR, Svensson LG, Webb JG, Makkar RR, et al. Two-year outcomes after transcatheter or surgical aortic-valve replacement. N Engl J Med. 2012;366(18):1686–95.

    Article  PubMed  CAS  Google Scholar 

  43. Ferrante G, Pagnotta P, Petronio AS, Bedogni F, Brambilla N, Fiorina C, et al. Sex differences in postprocedural aortic regurgitation and mid-term mortality after transcatheter aortic valve implantation. Catheter Cardiovasc Interv. 2014;84(2):264–71.

    Article  PubMed  Google Scholar 

  44. Unbehaun A, Pasic M, Dreysse S, Drews T, Kukucka M, Mladenow A, et al. Transapical aortic valve implantation: incidence and predictors of paravalvular leakage and transvalvular regurgitation in a series of 358 patients. J Am Coll Cardiol. 2012;59(3):211–21.

    Article  PubMed  Google Scholar 

  45. Rodes-Cabau J, Pibarot P, Suri RM, Kodali S, Thourani VH, Szeto WY, et al. Impact of aortic annulus size on valve hemodynamics and clinical outcomes after transcatheter and surgical aortic valve replacement: insights from the PARTNER Trial. Circ Cardiovasc Interv. 2014;7(5):701–11.

    Article  PubMed  Google Scholar 

  46. Haensig M, Lehmkuhl L, Rastan AJ, Kempfert J, Mukherjee C, Gutberlet M, et al. Aortic valve calcium scoring is a predictor of significant paravalvular aortic insufficiency in transapical-aortic valve implantation. Eur J Cardiothorac Surg. 2012;41(6):1234–40. discussion 40–1

    Article  PubMed  Google Scholar 

  47. Vavuranakis M, Kalogeras K, Lavda M, Kolokathis MA, Papaioannou T, Oikonomou E, et al. Correlation of CoreValve implantation ‘true cover index’ with short and mid-term aortic regurgitation: a novel index. Int J Cardiol. 2016;223:482–7.

    Article  PubMed  Google Scholar 

  48. Barbanti M, Yang TH, Rodes Cabau J, Tamburino C, Wood DA, Jilaihawi H, et al. Anatomical and procedural features associated with aortic root rupture during balloon-expandable transcatheter aortic valve replacement. Circulation. 2013;128(3):244–53.

    Article  PubMed  Google Scholar 

  49. •• Naoum C, Blanke P, Dvir D, Pibarot P, Humphries K, Webb J, et al. Clinical outcomes and imaging findings in women undergoing TAVR. JACC Cardiovasc Imaging. 2016;9(4):483–93. This is a comprehensive review of baseline characteristics and imaging findings in women undergoing TAVR.

    Article  PubMed  Google Scholar 

  50. Ribeiro HB, Webb JG, Makkar RR, Cohen MG, Kapadia SR, Kodali S, et al. Predictive factors, management, and clinical outcomes of coronary obstruction following transcatheter aortic valve implantation: insights from a large multicenter registry. J Am Coll Cardiol. 2013;62(17):1552–62.

    Article  PubMed  Google Scholar 

  51. Head SJ, Mokhles MM, Osnabrugge RL, Pibarot P, Mack MJ, Takkenberg JJ, et al. The impact of prosthesis-patient mismatch on long-term survival after aortic valve replacement: a systematic review and meta-analysis of 34 observational studies comprising 27,186 patients with 133,141 patient-years. Eur Heart J. 2012;33(12):1518–29.

    Article  PubMed  Google Scholar 

  52. Howell NJ, Keogh BE, Ray D, Bonser RS, Graham TR, Mascaro J, et al. Patient-prosthesis mismatch in patients with aortic stenosis undergoing isolated aortic valve replacement does not affect survival. Ann Thorac Surg. 2010;89(1):60–4.

    Article  PubMed  Google Scholar 

  53. Pibarot P, Weissman NJ, Stewart WJ, Hahn RT, Lindman BR, McAndrew T, et al. Incidence and sequelae of prosthesis-patient mismatch in transcatheter versus surgical valve replacement in high-risk patients with severe aortic stenosis: a PARTNER trial cohort—a analysis. J Am Coll Cardiol. 2014;64(13):1323–34.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Deeb GM, Chetcuti SJ, Yakubov SJ, Patel HJ, Grossman PM, Kleiman NS, et al. Impact of annular size on outcomes after surgical or transcatheter aortic valve replacement. Ann Thorac Surg. 2018;105(4):1129–36.

    Article  PubMed  Google Scholar 

  55. Ewe SH, Muratori M, Delgado V, Pepi M, Tamborini G, Fusini L, et al. Hemodynamic and clinical impact of prosthesis-patient mismatch after transcatheter aortic valve implantation. J Am Coll Cardiol. 2011;58(18):1910–8.

    Article  PubMed  Google Scholar 

  56. Bleiziffer S, Hettich I, Hutter A, Wagner A, Deutsch MA, Piazza N, et al. Incidence and impact of prosthesis-patient mismatch after transcatheter aortic valve implantation. J Heart Valve Dis. 2013;22(3):309–16.

    PubMed  Google Scholar 

  57. Jilaihawi H, Chin D, Spyt T, Jeilan M, Vasa-Nicotera M, Bence J, et al. Prosthesis-patient mismatch after transcatheter aortic valve implantation with the Medtronic-Corevalve bioprosthesis. Eur Heart J. 2010;31(7):857–64.

    Article  PubMed  Google Scholar 

  58. Dvir D, Webb JG, Bleiziffer S, Pasic M, Waksman R, Kodali S, et al. Transcatheter aortic valve implantation in failed bioprosthetic surgical valves. JAMA. 2014;312(2):162–70.

    Article  PubMed  CAS  Google Scholar 

  59. D’Ascenzo F, Gonella A, Moretti C, Omede P, Salizzoni S, La Torre M, et al. Gender differences in patients undergoing TAVI: a multicentre study. EuroIntervention. 2013;9(3):367–72.

    Article  PubMed  Google Scholar 

  60. Czarnecki A, Qiu F, Koh M, Prasad TJ, Cantor WJ, Cheema AN, et al. Clinical outcomes after trans-catheter aortic valve replacement in men and women in Ontario, Canada. Catheter Cardiovasc Interv. 2017;90(3):486–94.

    Article  PubMed  Google Scholar 

  61. Hayashida K, Morice MC, Chevalier B, Hovasse T, Romano M, Garot P, et al. Sex-related differences in clinical presentation and outcome of transcatheter aortic valve implantation for severe aortic stenosis. J Am Coll Cardiol. 2012;59(6):566–71.

    Article  PubMed  Google Scholar 

  62. Chieffo A, Petronio AS, Mehilli J, Chandrasekhar J, Sartori S, Lefevre T, et al. Acute and 30-day outcomes in women after TAVR: results from the WIN-TAVI (Women’s INternational Transcatheter Aortic Valve Implantation) real-world registry. JACC Cardiovasc Interv. 2016;9(15):1589–600.

    Article  PubMed  Google Scholar 

  63. Szerlip M, Gualano S, Holper E, Squiers JJ, White JM, Doshi D, et al. Sex-specific outcomes of transcatheter aortic valve replacement with the SAPIEN 3 valve: insights from the PARTNER II S3 high-risk and intermediate-risk cohorts. JACC Cardiovasc Interv. 2018;11(1):13–20.

    Article  PubMed  Google Scholar 

  64. • Chieffo A, Petronio AS, Mehilli J, Chandrasekhar J, Sartori S, Lefevre T, et al. 1-Year clinical outcomes in women after transcatheter aortic valve replacement: results from the first WIN-TAVI Registry. JACC Cardiovasc Interv. 2018;11(1):1–12. This is the first women-only TAVR registry that provides sex-specific information on factors associated with better outcomes.

    Article  PubMed  Google Scholar 

  65. Elassy SM, Elmidany AA, Elbawab HY. Urgent cardiac surgery during pregnancy: a continuous challenge. Ann Thorac Surg. 2014;97(5):1624–9.

    Article  PubMed  Google Scholar 

  66. Hodson R, Kirker E, Swanson J, Walsh C, Korngold EC, Ramelli S. Transcatheter aortic valve replacement during pregnancy. Circ Cardiovasc Interv. 2016;9(10)

Download references

Author information

Authors and Affiliations

  1. Echocardiography Laboratory, Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL, USA

    Christos G. Mihos MD

  2. Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Yawkey 5B, Boston, MA, 02114, USA

    Sheila L. Klassen MD & Evin Yucel MD

Authors
  1. Christos G. Mihos MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sheila L. Klassen MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Evin Yucel MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Evin Yucel MD.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Women’s Health

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mihos, C.G., Klassen, S.L. & Yucel, E. Sex-Specific Considerations in Women with Aortic Stenosis and Outcomes After Transcatheter Aortic Valve Replacement. Curr Treat Options Cardio Med 20, 52 (2018). https://doi.org/10.1007/s11936-018-0651-x

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11936-018-0651-x

Keywords

Search

Navigation