Clinical outcomes in women and men with small aortic annuli undergoing transcatheter aortic valve implantation: A multicenter, retrospective, propensity score-matched comparison. (15th May 2023)

• Record Type: Journal Article
• Authors: Leone, Pier Pasquale; Gohar, Aisha; Pagnesi, Matteo; Mangieri, Antonio; Stefanini, Giulio; Cacia, Michele; Cozzi, Ottavia; Barbanti, Marco; Teles, Rui; Adamo, Marianna; Taramasso, Maurizio; De Marco, Federico; Giannini, Francesco; Ohno, Yohei; Saia, Francesco; Buono, Andrea; Ielasi, Alfonso; Pighi, Michele; Ribichini, Flavio; Maffeo, Diego; Bedogni, Francesco; Kim, Won-Keun; Maisano, Francesco; Tamburino, Corrado; Van Mieghem, Nicolas M.; Colombo, Antonio; Reimers, Bernhard; Latib, Azeem; Regazzoli, Damiano
• Is Part Of: International journal of cardiology. Volume 379(2023)
• Page Start: 16
• Page End: 23
• Publication Date: 2023-05-15
• Subjects: TAVI -- Prosthesis-patient mismatch -- Small annuli -- Women -- Sex; BARC Bleeding Academic Research Consortium -- CABG coronary artery bypass grafting -- EOA effective orifice area -- LVOT left ventricular outflow tract -- NYHA New York Heart Association -- PPM prosthesis-patient mismatch -- PS propensity score -- SAVR surgical aortic valve replacement -- TAVI transcatheter aortic valve implantation; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2023.02.044
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Sex-specific characteristics in patients with aortic stenosis and small annuli undergoing transcatheter aortic valve implantation (TAVI) might affect clinical outcomes and hemodynamics. Methods: TAVI-SMALL 2 international retrospective registry included 1378 patients with severe aortic stenosis and small annuli (annular perimeter <72 mm or area < 400 mm2) treated with transfemoral TAVI at 16 high-volume centers between 2011 and 2020. Women ( n = 1233) were compared with men ( n = 145). One-to-one propensity score (PS) matching resulted in 99 pairs. Primary endpoint was incidence of all-cause mortality. Incidence of pre-discharge severe prosthesis-patient mismatch (PPM) and its association with all-cause mortality were investigated. Binary logistic and Cox regression were performed to adjust the treatment effect for PS quintiles. Results: Incidence of all-cause mortality at a median follow-up of 377 days did not differ between sex in the overall (10.3 vs. 9.8%, p = 0.842) and PS-matched (8.5 vs. 10.9%, p = 0.586) populations. After PS matching, pre-discharge severe PPM was numerically higher in women vs. men (10.2 vs. 4.3%), even though no evidence of a difference was found ( p = 0.275). Within the overall population, women with severe PPM suffered a higher incidence of all-cause mortality when compared to those with less than moderate PPM (log-rank p = 0.024) and less than severe PPM ( p = 0.027). Conclusions: No difference in all-cause mortality at medium-term follow-up was observed between women and men with aortic stenosis and small annuli undergoing TAVI. Incidence of pre-discharge severe PPM was numerically higher in women than men, and it was associated with increased all-cause mortality in women. Highlights: What is known: Clinical outcomes after surgical aortic valve replacement are worse in women than in men Women tend to have a survival advantage after transcatheter aortic valve implantation (TAVI). Sex-specific features in patients with small annuli undergoing TAVI might affect clinical outcomes and hemodynamics. What the study adds: Incidence of all-cause mortality was similar in women and men enrolled in TAVI-SMALL 2 registry. Incidence of severe prosthesis-patient mismatch (PPM) was numerically higher in women than men. Women with severe PPM suffered higher all-cause mortality than women with less than moderate or less than severe PPM.