Survival Rates Higher Among Women Undergoing TAVR

While women undergoing transcatheter aortic valve replacement (TAVR) procedures experience a higher incidence of post-surgery complications, these female patients demonstrate lower long-term mortality rates than men, according to new research.

In an effort to examine sex-specific differences in patients undergoing TAVR in the Placement of Aortic Transcatheter Valves (PARTNER) trial, a team of investigators conducted a secondary analysis of the randomized and non-randomized portions of the trial, evaluating high-risk and inoperable patients (1,220 women and 1,339 men) across 25 hospitals in the United States, Canada, and Germany. The researchers measured demographic characteristics, cardiac and non-cardiac comorbidities, mortality, stroke, rehospitalization, vascular complications, bleeding complications, and echocardiographic valve parameters.
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In comparison to male participants in the study, female patients were 28% more likely to have survived 1 year after undergoing TAVR, and were 18% less likely to have been readmitted to the hospital, even though women experienced higher rates of vascular complications (17% versus 10%), and major bleeding (11% compared to 8%) during the 30 days after surgery, according to the authors.  

“The most important observation here is that these data—in addition to others—turn the conventional assessment of risk of aortic valve replacement (AVR) on its head,” says lead author Susheel Kodali, MD, director of the heart valve program at Columbia University Medical Center.

Female patients undergoing surgical AVR have traditionally shown a higher risk of adverse outcomes compared to male patients, “if all other risk parameters are kept the same,” says Kodali, who is also director of Columbia University Medical Center’s interventional cardiology fellowship program.

“These data suggest that, if the patient is having a TAVR, then the reverse is actually true,” he concludes. “This is a very simple but powerful message for the treating clinician.”

The available evidence provided “not only from our study, but from other evaluations and meta analyses, suggests that elderly women with severe symptomatic aortic stenosis derive even greater benefit from TAVR than their male counterparts,” adds Karin Humphries, MBA, DSc, an associate professor in the faculty of medicine at the University of British Columbia, scientific director at the BC Centre for Improved Cardiovascular Health, and a co-author of the study.

“For older women with AS,” says Humphries, “TAVR is a treatment option that deserves consideration when physicians and patients are contemplating replacement of the aortic valve.”

—Mark McGraw

Reference

Kodali S, Williams M, et al. Sex-specific differences at presentation and outcomes among patients undergoing transcatheter aortic valve replacement: a cohort study. Ann Intern Med. 2016.