Gender differences in patients undergoing transcatheter aortic valve replacement: a cross-sectional study

Year 2022, Volume: 6 Issue: 3, 285 - 292, 31.12.2022

Adem Aktan Faruk Ertaş

https://doi.org/10.30565/medalanya.1177186

Cited By: 1

Abstract

Aim: Transcatheter aortic valve replacement (TAVR) is an effective treatment modality for patients with high-risk symptomatic severe aortic stenosis (AS) who are not suitable for surgery. Gender-related differences in TAVR are still deliberated, thus in this study we aimed to investigate the effect of gender on clinical outcomes in patients who underwent TAVR in our clinic.

Methods: 270 consecutive patients who underwent TAVR between January 2015 and January 2022 were included in the study. In addition to the patient's medical history, transthoracic or transesophageal echocardiography and computed tomography findings were examined to evaluate AS. Patients with symptomatic, high-risk severe aortic stenosis were treated with self-expanding Evolute-R devices. The patients were followed up for the first year after discharge. Follow-up was done by clinical visits and phone calls.

Results: In-hospital mortality (5.4% vs. 7.4%; p=0.507), death at one-year follow-up (14.9% vs. 13.1%, p=0.681), and major adverse cardiovascular and cerebrovascular events (MACCE) at one-year follow-up (26.4% versus 23.8%, p =0.627) rates, there was no statistically significant difference between male and female genders. Kaplan Meier curves were used for survival analysis, including one-year mortality and MACCE rates. Accordingly, no statistically significant difference was found between the two genders in terms of mortality and MACCE (respectively; p= 0.910; p=0.889).

Conclusion: In our patient group who underwent TAVR, we could not detect a significant difference in clinical outcomes between both genders. In recent years, the effect of gender on clinical outcomes may decrease with device and procedural developments.

Keywords

Aortic stenosis, gender, mortality, transcatheter aortic valve replacement

Transkateter Aort Kapak Replasmanı Uygulanan Hastalarda Cinsiyet Farklılıkları: Kesitsel Bir Çalışma

Abstract

Amaç: Transkateter aort kapak replasmanının (TAVR) cerrahiye uygun olmayan, yüksek riskli semptomatik şiddetli aort darlığı (AS) olan hastalar için etkili bir tedavi yöntemidir. TAVR’da cinsiyete bağlı farklılıklar hala tartışılmaktadır. Bu çalışma ile kliniğimizde TAVR uygulanan hastalarda cinsiyetin klinik sonuçlar üzerine etkisini araştırmayı amaçladık.

Yöntemler: Ocak 2015 ile Ocak 2022 tarihleri arasında TAVR yapılan ardışık 270 hasta çalışmaya dahil edildi. AS’yi değerlendirmek için hastanın tıbbi öyküsünün yanı sıra transtorasik veya transözofageal ekokardiyografi ve bilgisayarlı toraks tomografisi bulguları incelendi. Semptomatik, yüksek riskli şiddetli aort darlığı tespit edilen hastalara kendiliğinden genişleyebilen Evolute-R cihazlarıyla işlem yapıldı. Hastalar taburculuk sonrası ilk bir yıl takip edildi. Takipler klinik ziyaretler ve telefon görüşmeleriyle gerçekleşti.

Bulgular: Hastane içi mortalite (%5.4’e karşı %7.4 ; p=0.507), bir yıllık takipte ölüm (%14.9'e karşı %.13.1, p=0.681) ve bir yıllık takipte majör advers kardiyovasküler ve serebrovasküler olaylar (MACCE) (%26.4'e karşı %23.8, p=0.627) oranları açısından kadın ve erkek cinsiyetleri arasında istatistiksel olarak anlamlı farklılık saptanmadı. Bir yıllık mortalite ve MACCE oranlarını içeren sağkalım analizi Kaplan-Meier eğrileri kullanıldı. Buna göre her iki cinsiyet arasında mortalite ve MACCE açısından istatistiksel olarak anlamlı farklılık saptanmadı ( sırasıyla; p= 0.910; p =0.889).

Sonuç: TAVR yapılan hasta grubumuzda her iki cinsiyet arasında klinik sonlanımlar açısından önemli bir farklılık saptayamadık. Son yıllarda cihaz ve prosedürle ilişkili gelişmelerle cinsiyetin klinik sonuçlar üzerine etkisi azaltılmıştır.

Keywords

Aort darlığı, cinsiyet, mortalite, transkateter aort kapak replasmanı

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