Outcomes Following Aortic Stenosis Treatment (Transcatheter vs Surgical Replacement) in Women vs Men (From a Nationwide Analysis) - Archive ouverte HAL Access content directly
Journal Articles American Journal of Cardiology Year : 2021

Outcomes Following Aortic Stenosis Treatment (Transcatheter vs Surgical Replacement) in Women vs Men (From a Nationwide Analysis)

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1
Pierre Deharo
Arnaud Bisson
Julien Herbert
Thibaud Lacour
  • Function : Author
Christophe Saint Etienne
  • Function : Author
Nicolas Jaussaud
  • Function : Author
Pierre Morera
  • Function : Author
Jean-Charles Spychaj
  • Function : Author
Alizée Porto
  • Function : Author
Frederic Collart
Alexis Theron
Anne Bernard
Thierry Bourguignon
  • Function : Author
Laurent Fauchier

Abstract

Gender-differences in survival following transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) have been suggested. The objective of this study was to analyze outcomes following TAVR according to gender and to compare outcomes between TAVR and SAVR in women, at a nationwide level. Based on the French administrative hospital-discharge database, the study collected information for all consecutive patients treated with TAVR and SAVR between 2010 and 2019. Outcomes were analyzed according to gender and propensity score matching was used for the analysis of outcomes. In total 71,794 patients were identified in the database. After matching on baseline characteristics, we analyzed 12,336 women and 12,336 men treated with TAVR. In a second matched analysis, we compared 9,297 women treated with TAVR and 9,297 women treated with SAVR. Long term follow-up showed lower risk of all-cause death (12.7% vs 14.8%, hazard ratio (HR) 0.85, 95% CI 0.81 to 0.90) in women than men. Although the difference in cardiovascular death remained non-significant (5.8% vs 6.0%, HR 0.96, 95% CI 0.88 to 1.05), non-cardiovascular death was less frequent in women than in men following TAVR (6.9% vs 8.8% HR 0.78, 95%CI 0.72 to 0.84).When TAVR was compared with SAVR in women, long-term follow-up with TAVR showed higher rates of all-cause death (11.2% vs 6.5%, HR 1.91, 95%CI 1.78 to 2.05), cardiovascular death (5.0% vs 3.2%, HR 1.44, 95%CI 1.30 to 1.59), and non-cardiovascular death (6.2% vs 3.3%, HR 2.48, 95% CI 2.25 to 2.72). In conclusion, we observed that women undergoing TAVR have lower longterm all-cause mortality as compared with TAVR in men, driven by non-cardiovascular mortality. SAVR was associated with lower rates of long-term cardiovascular adverse events in women as compared with TAVR.
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Dates and versions

hal-03653435 , version 1 (27-04-2022)

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Pierre Deharo, Thomas Cuisset, Arnaud Bisson, Julien Herbert, Thibaud Lacour, et al.. Outcomes Following Aortic Stenosis Treatment (Transcatheter vs Surgical Replacement) in Women vs Men (From a Nationwide Analysis). American Journal of Cardiology, 2021, 154, pp.67-77. ⟨10.1016/j.amjcard.2021.05.046⟩. ⟨hal-03653435⟩
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