Females have higher one-year survival rate following TAVR

Females had a higher one-year survival rate following transcatheter aortic valve replacement (TAVR) compared with males who underwent the same procedure, according to a national registry analysis.

The researchers found that 78.7 percent of females and 75.5 percent of males were alive a year after undergoing TAVR. Women also had lower rates of major adverse cardiovascular events, the composite of death or MI and death or stroke.

Lead researcher Jaya Chandrasekhar, MBBS, of the Icahn School of Medicine at Mount Sinai in New York, and colleagues published their results online in the Journal of the American College of Cardiology on Dec. 19.

“These findings are significant because it may mean heart teams are overestimating the risks of TAVR in some women and that also may mean that valve replacement is underutilized,” Roxana Mehran, MD, the study’s senior researcher, said in a news release. “In other words, some women who could benefit from TAVR may not be getting it. These study results also highlight that we need a robust scoring assessment that is specific to TAVR and catered to women so we can make the best decisions. Additionally, further study is needed on the medium- to long-term causes of death in men and women who have had TAVR, particularly studies that are focused on learning more about vascular biology and why the aorta becomes more calcified in women.”

They evaluated data 11,808 women and 11,844 men who underwent TAVR from 2011 and 2014 and were enrolled in the Society of Thoracic Surgeons/American College of Cardiology (STS/ACC) registry. The STS and ACC released updated data from the registry on Dec. 9.

Female TAVR patients were slightly older than male patients had a lower prevalence of prior percutaneous or surgical coronary revascularization, atrial fibrillation, diabetes and lung disease. However, females were more likely to have moderate or severe mitral valve regurgitation and New York Heart Association functional class III or IV heart failure.

Females underwent TAVR more often using nontransfemoral access and surgical cutdown. They also had a smaller median sheath size and smaller valve size compared with males.

In-hospital vascular complications occurred in 8.27 percent of women and 4.39 percent of men, while bleeding occurred in 8.01 percent of women and 5.96 percent of men.

The one-year mortality rates were 21.3 percent for women and 24.5 percent for men.

Further, major adverse cardiovascular events occurred in 25.3 percent of women and 28.1 percent of men, the composite of death or MI occurred in 22.7 percent of women and 26.2 percent of men and death or stroke occurred in 24.2 percent of women and 26.6 percent of men. The incidence of one-year clinically significant bleeding was similar between females and males.

The researchers cited a few limitations of the study, including the reliance on observational registry data that were not centrally adjudicated. They also obtained the one-year data from claims records, which might have underestimated the number of events.

In addition, they noted that unmeasured confounders could have accounted for biased reporting of one-year survival and that most of the devices used were balloon-expandable. Further, they did not account for differences in TAVR time period or adjust for device types.

“A comparative sex-based analysis is warranted in patients undergoing TAVR with newer generation devices to examine for temporal changes in procedural complications and long-term outcomes,” the researchers wrote.