Long-Term Impact of Gender Differences After Transcatheter Aortic Valve Implantation

• Published in: CJC open (Online) 2024-12, Vol.6 (12), p.1453-1461
• Main Authors: Iwata, Juri, Hayashida, Kentaro, Arita, Ryo, Moriizumi, Tomonari, Kajino, Akiyoshi, Sakata, Shingo, Ryuzaki, Toshinobu, Shinada, Keitaro, Tsuruta, Hikaru, Kato, Jungo, Takahashi, Tatsuo, Yamazaki, Masataka, Shimizu, Hideyuki, Ieda, Masaki
• Format: Article
• Language: English
• ISSN: 2589-790X; 2589-790X
• DOI: 10.1016/j.cjco.2024.08.012

The short-term and midterm impact of gender differences on transcatheter aortic valve implantation (TAVI) has been studied. However, the impact on long-term clinical outcomes remains unclear. The objective of the study was to investigate the impact of gender differences after TAVI on long-term clinical outcomes and structural valve deterioration (SVD). Of the 672 consecutive patients who underwent TAVI, with balloon- or self-expandable valves, between 2013 and 2018, a total of 511 who underwent multidetector computed tomography analysis within 30 days after TAVI were included. Echocardiographic data were analyzed annually. The number of women was 343 (67.2%), and 90.7% of them had a small annulus (< 430 mm2). The effective orifice area was significantly smaller in women compared with that in men, whereas no difference occurred in the incidence of prosthesis–patient mismatch. The incidence of leaflet thrombosis detected by multidetector computed tomography was similar for women vs men (15.2% vs 13.1%, respectively; P = 0.53). During the median follow-up of 1844 days (interquartile range: 1190-2311 days), women showed a significantly decreased incidence of all-cause mortality (hazard ratio, 0.69; 95% confidence interval, 0.54-0.90; P = 0.005). The development of SVD was comparable (hazard ratio, 0.99; 95% confidence interval, 0.78-1.25, P = 0.90). Severe frailty and the balloon-expandable valves were the independent risk factors for all-cause mortality and SVD in women, respectively. Women had superior long-term clinical outcomes, compared with those of men, despite their having a small annulus. During long-term follow-up, the incidence of SVD in women was similar in the entire cohort, compared to that in men; however, balloon-expandable valves were possible risk factors for SVD in women. Les effets à court et à moyen terme de l'implantation valvulaire aortique par cathéter (IVAC) chez les hommes et chez les femmes ont été étudiés. Cependant, les résultats cliniques à long terme en fonction du sexe demeurent nébuleux. L’étude avait pour objectif d’évaluer dans quelle mesure le sexe a une influence sur les résultats cliniques à long terme et sur la détérioration structurelle de la valve (DSV) après une IVAC. Parmi les 672 patients consécutifs qui ont subi une IVAC, par une prothèse valvulaire sur ballonnet ou auto-extensible entre 2013 et 2018, un total de 511 patients qui avaient passé une analyse par tomodensitométrie multidétecteurs au cours des 30 jours s