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Is there a sex gap in outcomes of comparable patients supported with left ventricular assist devices?
Objectives Historically, females were described as suffering from worse outcomes after left ventricular assist device (LVAD) implantation. However, females' preoperative conditions are unique, making direct comparisons with males challenging. This study aimed to select through propensity score...
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| Published in: | Artificial organs 2022-11, Vol.46 (11), p.2293-2303 |
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| container_title | Artificial organs |
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| creator | Li, Tong Mariani, Silvia Bounader, Karl Boethig, Dietmar Schöde, Alexandra Homann, Katharina Hanke, Jasmin S. Napp, L. Christian Merzah, Ali Saad Dogan, Guenes Haverich, Axel Schmitto, Jan D. |
| description | Objectives
Historically, females were described as suffering from worse outcomes after left ventricular assist device (LVAD) implantation. However, females' preoperative conditions are unique, making direct comparisons with males challenging. This study aimed to select through propensity score (PS) matching two preoperatively comparable populations of females and males and test if any real sex‐related difference exists regarding survival and adverse events after LVAD implantation.
Methods
This retrospective single‐center observational study investigated patients who received LVAD implantation between 2010 and 2018. PS matching was applied to balance preoperative heterogeneity between males and females. Primary endpoint was survival at follow‐up. Secondary endpoints included perioperative outcomes and LVAD‐related adverse events.
Results
92 fully comparable females(n = 46) and males(n = 46) were selected after PS matching (median age:57 years, min–max:18–75). 26.1% of patients required preoperative mechanical circulatory support. Females needed more intraoperative fresh frozen plasma (p |
| doi_str_mv | 10.1111/aor.14333 |
| format | article |
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Historically, females were described as suffering from worse outcomes after left ventricular assist device (LVAD) implantation. However, females' preoperative conditions are unique, making direct comparisons with males challenging. This study aimed to select through propensity score (PS) matching two preoperatively comparable populations of females and males and test if any real sex‐related difference exists regarding survival and adverse events after LVAD implantation.
Methods
This retrospective single‐center observational study investigated patients who received LVAD implantation between 2010 and 2018. PS matching was applied to balance preoperative heterogeneity between males and females. Primary endpoint was survival at follow‐up. Secondary endpoints included perioperative outcomes and LVAD‐related adverse events.
Results
92 fully comparable females(n = 46) and males(n = 46) were selected after PS matching (median age:57 years, min–max:18–75). 26.1% of patients required preoperative mechanical circulatory support. Females needed more intraoperative fresh frozen plasma (p < 0.001) and platelets transfusions (p = 0.008) compared to males, but postoperative outcomes were comparable between groups. In‐hospital, 1 and 2‐year survival were 78.3%, 69.6% and 65.2%, respectively, with no differences between groups. Survival probability remained comparable up to 8 years of follow‐up (p = 0.35). Overall, females showed a higher rate of strokes (p = 0.039) compared to males in the follow‐up time.
Conclusions
After reducing preoperative heterogeneity between females and males, survival after LVAD implantation does not differ based on sex. However, differences might exist in terms of higher transfusions and strokes in females. Reducing preoperative sex disparities and developing intraoperative and anticoagulation strategies which acknowledge sex‐related variations might help abolishing differences in LVAD outcomes.
Sex gap in comparable LVAD patients.</description><identifier>ISSN: 0160-564X</identifier><identifier>EISSN: 1525-1594</identifier><identifier>DOI: 10.1111/aor.14333</identifier><identifier>PMID: 35686944</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Anticoagulants ; Females ; Heart ; Heterogeneity ; Implantation ; left ventricular assist device ; long‐term outcomes ; Males ; Matching ; Patients ; Sex ; sex differences ; Survival ; Ventricle ; Ventricular assist devices</subject><ispartof>Artificial organs, 2022-11, Vol.46 (11), p.2293-2303</ispartof><rights>2022 The Authors. published by International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.</rights><rights>This article is protected by copyright. All rights reserved.</rights><rights>2022. This article is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3883-6fe76c5d0cbea54ea67c229dc3b2301b37043cdfc867e4f41609178ffb7dce013</citedby><cites>FETCH-LOGICAL-c3883-6fe76c5d0cbea54ea67c229dc3b2301b37043cdfc867e4f41609178ffb7dce013</cites><orcidid>0000-0002-2041-5823 ; 0000-0001-9945-0842 ; 0000-0002-2238-1399 ; 0000-0002-1434-6905 ; 0000-0002-5984-9426</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35686944$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Li, Tong</creatorcontrib><creatorcontrib>Mariani, Silvia</creatorcontrib><creatorcontrib>Bounader, Karl</creatorcontrib><creatorcontrib>Boethig, Dietmar</creatorcontrib><creatorcontrib>Schöde, Alexandra</creatorcontrib><creatorcontrib>Homann, Katharina</creatorcontrib><creatorcontrib>Hanke, Jasmin S.</creatorcontrib><creatorcontrib>Napp, L. Christian</creatorcontrib><creatorcontrib>Merzah, Ali Saad</creatorcontrib><creatorcontrib>Dogan, Guenes</creatorcontrib><creatorcontrib>Haverich, Axel</creatorcontrib><creatorcontrib>Schmitto, Jan D.</creatorcontrib><title>Is there a sex gap in outcomes of comparable patients supported with left ventricular assist devices?</title><title>Artificial organs</title><addtitle>Artif Organs</addtitle><description>Objectives
Historically, females were described as suffering from worse outcomes after left ventricular assist device (LVAD) implantation. However, females' preoperative conditions are unique, making direct comparisons with males challenging. This study aimed to select through propensity score (PS) matching two preoperatively comparable populations of females and males and test if any real sex‐related difference exists regarding survival and adverse events after LVAD implantation.
Methods
This retrospective single‐center observational study investigated patients who received LVAD implantation between 2010 and 2018. PS matching was applied to balance preoperative heterogeneity between males and females. Primary endpoint was survival at follow‐up. Secondary endpoints included perioperative outcomes and LVAD‐related adverse events.
Results
92 fully comparable females(n = 46) and males(n = 46) were selected after PS matching (median age:57 years, min–max:18–75). 26.1% of patients required preoperative mechanical circulatory support. Females needed more intraoperative fresh frozen plasma (p < 0.001) and platelets transfusions (p = 0.008) compared to males, but postoperative outcomes were comparable between groups. In‐hospital, 1 and 2‐year survival were 78.3%, 69.6% and 65.2%, respectively, with no differences between groups. Survival probability remained comparable up to 8 years of follow‐up (p = 0.35). Overall, females showed a higher rate of strokes (p = 0.039) compared to males in the follow‐up time.
Conclusions
After reducing preoperative heterogeneity between females and males, survival after LVAD implantation does not differ based on sex. However, differences might exist in terms of higher transfusions and strokes in females. Reducing preoperative sex disparities and developing intraoperative and anticoagulation strategies which acknowledge sex‐related variations might help abolishing differences in LVAD outcomes.
Sex gap in comparable LVAD patients.</description><subject>Anticoagulants</subject><subject>Females</subject><subject>Heart</subject><subject>Heterogeneity</subject><subject>Implantation</subject><subject>left ventricular assist device</subject><subject>long‐term outcomes</subject><subject>Males</subject><subject>Matching</subject><subject>Patients</subject><subject>Sex</subject><subject>sex differences</subject><subject>Survival</subject><subject>Ventricle</subject><subject>Ventricular assist devices</subject><issn>0160-564X</issn><issn>1525-1594</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><recordid>eNp1kEFLHDEUgENR6nbtoX9AAl7sYTSZZJKZUxFpVRAWxEJvIZN50cjsZpqX0frvTV3bg2AuCeTj472PkC-cHfNyTmxMx1wKIT6QBW_qpuJNJ3fIgnHFqkbJX3vkE-I9Y0xLpj6SPdGoVnVSLghcIs13kIBaivCH3tqJhg2Nc3ZxDUijp-Ux2WT7Eehkc4BNRorzNMWUYaCPId_REXymD-UnBTePNlGLGDDTAR6CA_y2T3a9HRE-v95L8vPH95uzi-pqdX55dnpVOdG2olIetHLNwFwPtpFglXZ13Q1O9LVgvBeaSeEG71qlQXpZ1uu4br3v9eCAcbEkR1vvlOLvGTCbdUAH42g3EGc0tdKNYqVQV9DDN-h9nNOmTGdqXXedEMVdqK9byqWImMCbKYW1TU-GM_O3vSntzUv7wh68Gud-DcN_8l_sApxsgccwwtP7JnO6ut4qnwHVMo5Z</recordid><startdate>202211</startdate><enddate>202211</enddate><creator>Li, Tong</creator><creator>Mariani, Silvia</creator><creator>Bounader, Karl</creator><creator>Boethig, Dietmar</creator><creator>Schöde, Alexandra</creator><creator>Homann, Katharina</creator><creator>Hanke, Jasmin S.</creator><creator>Napp, L. Christian</creator><creator>Merzah, Ali Saad</creator><creator>Dogan, Guenes</creator><creator>Haverich, Axel</creator><creator>Schmitto, Jan D.</creator><general>Wiley Subscription Services, Inc</general><scope>24P</scope><scope>WIN</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QO</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>P64</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-2041-5823</orcidid><orcidid>https://orcid.org/0000-0001-9945-0842</orcidid><orcidid>https://orcid.org/0000-0002-2238-1399</orcidid><orcidid>https://orcid.org/0000-0002-1434-6905</orcidid><orcidid>https://orcid.org/0000-0002-5984-9426</orcidid></search><sort><creationdate>202211</creationdate><title>Is there a sex gap in outcomes of comparable patients supported with left ventricular assist devices?</title><author>Li, Tong ; Mariani, Silvia ; Bounader, Karl ; Boethig, Dietmar ; Schöde, Alexandra ; Homann, Katharina ; Hanke, Jasmin S. ; Napp, L. Christian ; Merzah, Ali Saad ; Dogan, Guenes ; Haverich, Axel ; Schmitto, Jan D.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3883-6fe76c5d0cbea54ea67c229dc3b2301b37043cdfc867e4f41609178ffb7dce013</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Anticoagulants</topic><topic>Females</topic><topic>Heart</topic><topic>Heterogeneity</topic><topic>Implantation</topic><topic>left ventricular assist device</topic><topic>long‐term outcomes</topic><topic>Males</topic><topic>Matching</topic><topic>Patients</topic><topic>Sex</topic><topic>sex differences</topic><topic>Survival</topic><topic>Ventricle</topic><topic>Ventricular assist devices</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Li, Tong</creatorcontrib><creatorcontrib>Mariani, Silvia</creatorcontrib><creatorcontrib>Bounader, Karl</creatorcontrib><creatorcontrib>Boethig, Dietmar</creatorcontrib><creatorcontrib>Schöde, Alexandra</creatorcontrib><creatorcontrib>Homann, Katharina</creatorcontrib><creatorcontrib>Hanke, Jasmin S.</creatorcontrib><creatorcontrib>Napp, L. Christian</creatorcontrib><creatorcontrib>Merzah, Ali Saad</creatorcontrib><creatorcontrib>Dogan, Guenes</creatorcontrib><creatorcontrib>Haverich, Axel</creatorcontrib><creatorcontrib>Schmitto, Jan D.</creatorcontrib><collection>Open Access: Wiley-Blackwell Open Access Journals</collection><collection>Wiley Free Archive</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Biotechnology Research Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Artificial organs</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Li, Tong</au><au>Mariani, Silvia</au><au>Bounader, Karl</au><au>Boethig, Dietmar</au><au>Schöde, Alexandra</au><au>Homann, Katharina</au><au>Hanke, Jasmin S.</au><au>Napp, L. Christian</au><au>Merzah, Ali Saad</au><au>Dogan, Guenes</au><au>Haverich, Axel</au><au>Schmitto, Jan D.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Is there a sex gap in outcomes of comparable patients supported with left ventricular assist devices?</atitle><jtitle>Artificial organs</jtitle><addtitle>Artif Organs</addtitle><date>2022-11</date><risdate>2022</risdate><volume>46</volume><issue>11</issue><spage>2293</spage><epage>2303</epage><pages>2293-2303</pages><issn>0160-564X</issn><eissn>1525-1594</eissn><abstract>Objectives
Historically, females were described as suffering from worse outcomes after left ventricular assist device (LVAD) implantation. However, females' preoperative conditions are unique, making direct comparisons with males challenging. This study aimed to select through propensity score (PS) matching two preoperatively comparable populations of females and males and test if any real sex‐related difference exists regarding survival and adverse events after LVAD implantation.
Methods
This retrospective single‐center observational study investigated patients who received LVAD implantation between 2010 and 2018. PS matching was applied to balance preoperative heterogeneity between males and females. Primary endpoint was survival at follow‐up. Secondary endpoints included perioperative outcomes and LVAD‐related adverse events.
Results
92 fully comparable females(n = 46) and males(n = 46) were selected after PS matching (median age:57 years, min–max:18–75). 26.1% of patients required preoperative mechanical circulatory support. Females needed more intraoperative fresh frozen plasma (p < 0.001) and platelets transfusions (p = 0.008) compared to males, but postoperative outcomes were comparable between groups. In‐hospital, 1 and 2‐year survival were 78.3%, 69.6% and 65.2%, respectively, with no differences between groups. Survival probability remained comparable up to 8 years of follow‐up (p = 0.35). Overall, females showed a higher rate of strokes (p = 0.039) compared to males in the follow‐up time.
Conclusions
After reducing preoperative heterogeneity between females and males, survival after LVAD implantation does not differ based on sex. However, differences might exist in terms of higher transfusions and strokes in females. Reducing preoperative sex disparities and developing intraoperative and anticoagulation strategies which acknowledge sex‐related variations might help abolishing differences in LVAD outcomes.
Sex gap in comparable LVAD patients.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>35686944</pmid><doi>10.1111/aor.14333</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0002-2041-5823</orcidid><orcidid>https://orcid.org/0000-0001-9945-0842</orcidid><orcidid>https://orcid.org/0000-0002-2238-1399</orcidid><orcidid>https://orcid.org/0000-0002-1434-6905</orcidid><orcidid>https://orcid.org/0000-0002-5984-9426</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Anticoagulants Females Heart Heterogeneity Implantation left ventricular assist device long‐term outcomes Males Matching Patients Sex sex differences Survival Ventricle Ventricular assist devices |
| title | Is there a sex gap in outcomes of comparable patients supported with left ventricular assist devices? |
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