Sex-specific in-hospital outcomes of transcatheter aortic valve replacement with third generation transcatheter heart valves.
Simard, Trevor; Alqahtani, Fahad; Hibbert, Benjamin; Mamas, Mamas A.; El-Hajj, Stephanie; Harris, Alyssa H.; Hohmann, Samuel F.; Alkhouli, Mohamad
Mamas Mamas email@example.com
Alyssa H. Harris
Samuel F. Hohmann
BACKGROUND: Sex-based differences in transcatheter aortic valve replacement (TAVR) outcomes have been previously documented. However, whether these differences persist with contemporary third generation transcatheter heart valves (THVs) is unknown. METHODS: We utilized Vizient's clinical database/resource manager (CDB/RM™) to identify patients who underwent TAVR between January 1, 2018 and March 31, 2020 to compare in-hospital outcomes between males and females. The primary endpoint was in-hospital mortality. Secondary endpoints included key in-hospital complications, length of stay, discharge disposition, and cost. Unadjusted, propensity-score matched and risk-adjusted analyses of outcomes were performed. RESULTS: During the study period, 44,280 patients (24,842 males, 19,438 females) underwent TAVR. The primary endpoint of in-hospital mortality was higher in females than in males (1.6 vs. 1.1% p <?.001) in unadjusted analysis and persisted following propensity matching (1.6 vs. 0.9%, p <?.001) and multivariable logistic regression with various risk-adjustment models. In the most comprehensive model adjusting for age, race, and clinical comorbidities, female sex was associated with 34% greater odds of in-hospital death (95% CI 20-50%, p <?.001). Unadjusted and risk-adjusted rates of post-TAVR stroke, vascular complication, and blood transfusion were higher in females. Moreover, females demonstrated longer hospitalizations, higher costs and reduced rates of independent discharge home. CONCLUSION: Sex-based differences in TAVR in-hospital outcomes persist in contemporary practice with third generation transcatheter heart valves. Further research is needed to assess the reasons for these observed disparities and to identify effective mitigation strategies.
|Acceptance Date||Dec 27, 2020|
|Publication Date||Jul 1, 2021|
|Journal||Catheter Cardiovasc Interv|
|Pages||176 - 183|
|Keywords||Aortic Valve; transcatheter heart valves; sex|