Women 40% less likely to die after TAVI than men

August 28, 2012

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 where the aortic valve becomes obstructed, leading to life-threatening . If left untreated, half of all patients do not survive for more than two years after the initial onset of symptoms. Traditionally, treatment involves 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-. 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 .

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 , Placement of Aortic Transcatheter Valves (PARTNER) A, compared TAVI to and demonstrated patients did just as well with either procedure.

"The PARTNER trial also sparked considerable interest in ," 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 '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 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 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."

Explore further: Gender differences in clinical presentation and outcome of transcatheter aortic valve implantation

More information:

References

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.

Related Stories

Gender differences in clinical presentation and outcome of transcatheter aortic valve implantation

August 29, 2011
Severe aortic stenosis (AS) is increasing in frequency as the population ages. For a subset of patients in whom surgical conventional aortic valve replacement is excluded due to severe co-morbidities, an alternative to surgical ...

Transcatheter aortic valve implantation shows promise in patients with severe aortic stenosis

April 10, 2012
German researchers report success with transcatheter aortic valve implantation (TAVI) in patients with low-flow, low-gradient aortic stenosis—a special form of aortic stenosis that is difficult to treat. Results published ...

Results of the STACCATO Trial reported at TCT 2011

November 10, 2011
Researchers leading a clinical trial said that transapical transcatheter aortic valve implantation (a-TAVI) may be inferior to surgical aortic valve replacement (SAVR) in operable elderly patients. However results were only ...

TAVI improves quality of life in patients with severe aortic stenosis for at least 1 year

August 28, 2012
Transcatheter aortic valve implantation (TAVI) leads to meaningful improvements in health-related quality of life in patients with severe aortic stenosis that are maintained for at least 1 year, according to a study presented ...

Recommended for you

Could this protein protect people against coronary artery disease?

November 17, 2017
The buildup of plaque in the heart's arteries is an unfortunate part of aging. But by studying the genetic makeup of people who maintain clear arteries into old age, researchers led by UNC's Jonathan Schisler, PhD, have identified ...

Raising 'good' cholesterol fails to protect against heart disease

November 16, 2017
Raising so-called 'good' cholesterol by blocking a key protein involved in its metabolism does not protect against heart disease or stroke, according to a large genetic study of 150,000 Chinese adults published in the journal ...

New model estimates odds of events that trigger sudden cardiac death

November 16, 2017
A new computational model of heart tissue allows researchers to estimate the probability of rare heartbeat irregularities that can cause sudden cardiac death. The model, developed by Mark Walker and colleagues from Johns ...

Popular e-cigarette liquid flavorings may change, damage heart muscle cells

November 16, 2017
Chemicals used to make some popular e-cigarette liquid flavorings—including cinnamon, clove, citrus and floral—may cause changes or damage to heart muscle cells, new research indicates.

Possible use for botulinum toxin to treat atrial fibrillation

November 16, 2017
From temporarily softening wrinkles to easing migraines, botulinum toxin has become a versatile medical remedy because of its ability to block nerve signals that can become bothersome or risky.

Proteome of the human heart mapped for the first time

November 15, 2017
A healthy heart beats about two billion times during a lifetime, thanks to the interplay of more than 10,000 proteins. Researchers from the Max Planck Institute of Biochemistry (MPIB) and the German Heart Centre at the Technical ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.