Male vs. female aortic valve-in-valve implantation: Insights from the Valve-In-Valve International Data Registry (VIVID)
Tara Jones1, Matheus Simonato2, Moses Mathur1, Mark Reisman1, John Webb3, Danny Dvir1.
1University of Washington Medical Center, Seattle, WA, USA, 2Escola Paulista de Medicina - UNIFESP, Sao Paulo, Brazil, 3St. Paul's Hospital, Vancouver, BC, Canada.
Objective: Valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) is an alternative to redo open heart surgery for patients with a failing aortic bioprosthesis. We compared clinical outcomes after ViV-TAVI performed in male versus female patients for failing bioprostheses using a large global registry.
Methods and Results: A total of 1646 aortic ViV procedures from the ViV International Data (VIVID) registry were investigated (950 male, 696 female). Male patients were younger at the time of ViV procedure (76.4 ± 10.1 vs. 79.5 ± 8.2 years) and had larger surgical bioprosthesis (true internal diameter 20.9 ± 2.3 vs. 19.1 ± 2.1 mm). Male patients had lower baseline risk vs. females based on logistic EuroSCORE (27.6 ± 17.5 vs. 31.3 ± 16.3), EuroSCORE II (13.6 ± 8.4 vs. 15.8 ± 8.8), and STS mortality (8.7 ± 7.6 vs. 10.5 ± 9.3). Bioprosthetic failure was due to isolated stenosis in 46% of females compared to 33.5% of males (p < 0.001). Major bleeding was more common in females (7.7% vs. 5%, p = 0.02) but there was otherwise no significant difference in procedural complications. Though similar device types were used, transcatheter prosthesis size was larger in males (25.2 ± 2.2 vs. 24 ± 1.8 mm). Post procedural valve hemodynamics were more favorable in males with greater final aortic valve area (1.54 ± 0.5 vs. 1.37 ± 0.44 cm2, p < 0.001) and lower mean gradient (15.4 ± 8.5 vs. 17.3 ± 9.3 mmHg, p <0.001). Additionally, female patients had higher 30-day all-cause mortality (6.2% vs. 4.2%, p = 0.07) and higher 30-day cardiovascular mortality (5.9% vs. 3.7%, p = 0.04).
Conclusions: All cause and cardiovascular mortality at 30 days post ViV TAVI was higher in female patients compared to males. Male patients undergoing ViV TAVI for failing aortic bioprothesis had more favorable valve hemodynamics as compared to female patients despite similar procedural technique and device type.
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