Women 40% less likely to die after TAVI than men
Women with severe aortic stenosis are 40% less likely to die after transcatheter aortic valve implantation (TAVI) than men, reveals the latest data from the largest study to date of gender differences in outcomes after TAVI. The findings were presented at ESC Congress 2012 by Professor Karin Humphries from St. Paul's Hospital.
More than 1.5 million people in the US suffer from aortic stenosis, a progressive disease where the aortic valve becomes obstructed, leading to life-threatening heart problems. If left untreated, half of all patients do not survive for more than two years after the initial onset of symptoms. Traditionally, treatment involves open heart surgery to replace the diseased valve; however in frail and elderly patients the surgery is highly risky and sometimes simply not possible to perform.
A groundbreaking non-surgical treatment, known as transcatheter aortic valve implantation (TAVI), has shown considerable promise in these high-risk patients. Pioneered in Canada in 2005 by interventional cardiologist Dr John Webb and his team at St. Paul's Hospital in Vancouver, the TAVI procedure is minimally invasive and does not require major surgery.
Since the first successful valve implantation by Dr Alain Cribier from France, more than 50,000 procedures have been performed worldwide. To study the efficacy of the technique, researchers from the pivotal randomized trial, Placement of Aortic Transcatheter Valves (PARTNER) A, compared TAVI to traditional surgery and demonstrated patients did just as well with either procedure.
"The PARTNER trial also sparked considerable interest in gender differences," said Professor Humphries. "Women, at one year, were found to have lower mortality with TAVI when compared to men (1). However, the trial did not adjust for potential baseline differences between women and men. The US Food and Drug Administration's Circulatory Systems Devices Panel for the PARTNER trial has requested additional data on gender and longer-term results."
"Recent publications have sought to elucidate these gender differences in TAVI outcomes but have shown limited and conflicting results," she added. "A single centre study of 305 high-risk patients undergoing TAVI found no gender difference in 30-day mortality (2), while another study of 260 consecutive TAVI patients reported better 1-year survival in women, but failed to adjust for baseline differences (3)."
In response, Professor Humphries, in collaboration with colleagues from St. Paul's Hospital and Quebec's Laval Hospital, aimed to thoroughly examine gender differences in outcome after TAVI using real-world data from these two leading centres in TAVI procedures.
For this study, data from 641 consecutive, high-risk patients (51.3% women) with severe aortic stenosis undergoing TAVI between January 2005 and September 2011 were prospectively captured. Patients were followed for up to 2 years, with mortality as the primary outcome.
"One of the biggest challenges in cardiovascular disease research is that women typically constitute only 20-25% of the study population and there aren't enough numbers to determine whether treatment benefits extend to women," said Professor Humphries. "In our study women comprised more than half the cohort, perhaps because of the older age of subjects with severe aortic stenosis."
At baseline, women and men in the study population were of similar age, had similar aortic valve size in relation to their body size, and had similar extent of heart failure. Women had higher pressures across their aortic valve and worse kidney function but better ejection fractions. Men had more comorbidities such as prior heart attacks, prior revascularization, and chronic obstructive pulmonary disease (COPD).
After TAVI, women were more likely than men to experience serious procedural complications (12.4% vs. 5.4%) and major bleeds (21.6% vs. 15.8%). Yet, despite these adverse events, mortality remained lower in women at 30 days (6.5% vs. 11.2%).
Professor Humphries said: "We made extensive adjustments for demographic, procedural, and clinical differences between women and men to try and explain the observed gender difference. However, the female advantage persisted over the follow-up period with a hazard ratio of 0.60; meaning women were 40% less likely to die after receiving the treatment than men."
"Historically men have done better than women in almost all cardiac procedures," said Professor Humphries. "But for the first time, our study has shown women seem to benefit more than men after TAVI."
She added: "The results of the study, when considered in context of the PARTNER A trial findings, suggest TAVI might be the preferred mode of treatment in elderly women with symptomatic severe aortic stenosis."
1 Smith CR, Leon MB, Mack MJ, Miller DC, Moses JW, Svensson LG, Tuzcu EM, Webb JG, Fontana GP, Makkar RR, Williams M, Dewey T, Kapadia S, Babaliaros V, Thourani VH, Corso P, Pichard AD, Bavaria JE, Herrmann HC, Akin JJ, Anderson WN, Wang D, Pocock SJ; PARTNER Trial Investigators. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med. 2011;364(23):2187-2198.
2 Buchanan GL, Chieffo A, Montorfano M, Maisano F, Latib A, Godino C, Cioni M, Gullace MA, Franco A, Gerli C, Alfieri O, Colombo A. The role of sex on VARC outcomes following transcatheter aortic valve implantation with both Edwards SAPIEN™ and Medtronic CoreValve ReValving System® devices: the Milan registry. EuroIntervention. 2011;7(5):556-563.
3 Hayashida K, Morice MC, Chevalier B, Hovasse T, Romano M, Garot P, Farge A, Donzeau-Gouge P, Bouvier E, Cormier B, Lefèvre T. Sex-related differences in clinical presentation and outcome of transcatheter aortic valve implantation for severe aortic stenosis. J Am Coll Cardiol. 2012;59(6):566-571.
Provided by European Society of Cardiology
- Gender differences in clinical presentation and outcome of transcatheter aortic valve implantation Aug 29, 2011 | not rated yet | 0
- Transcatheter aortic valve implantation as good as traditional surgery for high risk, operable patients Apr 05, 2011 | not rated yet | 0
- Transcatheter aortic valve implantation shows promise in patients with severe aortic stenosis Apr 10, 2012 | not rated yet | 0
- Surgical aortic valve replacement should remain the standard treatment for aortic stenosis Oct 20, 2010 | not rated yet | 0
- Results of the STACCATO Trial reported at TCT 2011 Nov 10, 2011 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
Force Between Two Concentric Solenoids
49 minutes ago Imagine a finite length solenoid with outer radius R1 and inner radius R2. This solenoid has a time-varying current going though it. This solenoid is...
Synchrotron, question about insertion devices and electron velocity
1 hour ago When an electron enters an insertion device (wiggler and undulator) from the storage ring in a synchrotron the tangential velocity is equal to the...
Equating differentials => equating coefficients
2 hours ago Hi all, In thermodynamics one often has equations like A dx + B dy = ∂f/∂x dx + ∂f/∂y dy From which follows A = ∂f/∂x B = ∂f/∂y
The idea behind a reverse shock
8 hours ago So in a supernova explosion for example (5th slide) http://www.astro.princeton.edu/~burrows/classes/541/blastwavesChisari.pdf Ambient medium is...
Guass's Law for a charge distribution
8 hours ago First, this is not a homework question, just something I've been confused about for some time. I understand how to use Guass's law in many ways but...
9 hours ago Hello :) i'm new to this forum, so excuse me for my straightforwardness ;) I'm working on my bachelor work and i can't find a solution. I'm writing...
- More from Physics Forums - Classical Physics
More news stories
Heart failure accelerates the aging process and brings on early andropausal syndrome (AS), according to research presented today at the Heart Failure Congress 2013. AS, also referred to as male 'menopause', was four times ...
Cardiology 14 hours ago | not rated yet | 1
Mortality and length of stay are highest in heart failure patients admitted in January, on Friday, and overnight, according to research presented today at the Heart Failure Congress 2013. The analysis of nearly 1 million ...
Cardiology 14 hours ago | not rated yet | 0
Coenzyme Q10 decreases all cause mortality by half, according to the results of a multicentre randomised double blind trial presented today at Heart Failure 2013 congress. It is the first drug to improve heart failure mortality ...
Cardiology 14 hours ago | 5 / 5 (2) | 5
Transcatheter aortic valve implantation (TAVI) is effective and safe in Asian patients, according to early experience based on first results from a multicentre Asian registry reported at EuroPCR 2013.
Cardiology May 24, 2013 | not rated yet | 0
Routinely measuring fractional flow reserve (FFR) using pressure wire assessment during coronary angiography for diagnosis of chest pain leads to significant changes in the management of one in four patients, according to ...
Cardiology May 24, 2013 | not rated yet | 0
(HealthDay)—Animals make great companions for senior citizens, but elderly people who always drive with a pet in the car are far more likely to crash than those who never drive with a pet, researchers have ...
6 hours ago | not rated yet | 1
(AP)—Department of Justice lawyers have again asked a federal appeals court in New York to delay lifting age restrictions and prescription requirements on an emergency contraceptive popularly known as the morning-after ...
13 hours ago | not rated yet | 0
(Medical Xpress)—A research team, led by Jeremy Barr, a biology post-doctoral fellow, unveils a new immune system that protects humans and animals from infection.
May 20, 2013 | 4.8 / 5 (30) | 9 |
Until now, little was scientifically known about the human potential to cultivate compassion—the emotional state of caring for people who are suffering in a way that motivates altruistic behavior.
May 22, 2013 | 5 / 5 (4) | 6 |
Women at a particular stage in their monthly menstrual cycle may be more vulnerable to some of the psychological side-effects associated with stressful experiences, according to a study from UCL.
May 24, 2013 | 4 / 5 (4) | 4 |
Salamanders' immune systems are key to their remarkable ability to regrow limbs, and could also underpin their ability to regenerate spinal cords, brain tissue and even parts of their hearts, scientists have ...
May 20, 2013 | 4.9 / 5 (7) | 5 |