Clinical impact of sex differences and procedural setting in transcatheter aortic valve implantation

• Published in: Cardiovascular revascularization medicine
• Main Authors: Ravani, Lis Victória, Ribeiro, Henrique Barbosa, Calomeni, Pedro, de Brito, Fábio Sandoli, Bernardi, Fernando, Lemos, Pedro, Feres, Fausto, Siqueira, Dimytri Alexandre, Costa, Ricardo, Sarmento-Leite, Rogério, Mangione, Fernanda, Mangione, José Armando, Thiago, Luiz Eduardo Koenig São, de Lima, Valter Correia, Oliveira, Adriano Dias Dourado, Marino, Marcos Antônio, Cardoso, Carlos José Francisco, Caramori, Paulo Ricardo Avancini, Tumelero, Rogério Tadeu, Portela, Antenor Lages Fortes, Prudente, Maurício Lopes, Henriques, Leônidas Alvarenga, de Freitas Souza, Fabio Solano, Bezerra, Cristiano Guedes, de Almeida Prado Junior, Guy Fernandes, de Freitas, Leandro Zacarias Figueiredo, Nogueira, Ederlon Ferreira, Meirelle, George César Ximenes, Pope, Renato Bastos, Guérios, Ênio Eduardo, de Andrade, Pedro Beraldo, de Moura Santos, Luciano, de Sá Marchi, Mauricio Felippi, Esteves, Vinicius Borges Cardozo, Abizaid, Alexandre
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 24-09-2024
• Subjects: Aortic stenosis; Healthcare disparities; Sex characteristics; Transcatheter aortic valve implantation; Aortic stenosis; Transcatheter aortic valve implantation; Healthcare disparities; Sex characteristics
• ISSN: 1553-8389; 1878-0938; 1878-0938
• DOI: 10.1016/j.carrev.2024.09.014

Transcatheter aortic valve implantation (TAVI) is a well-established treatment for symptomatic patients with aortic stenosis. Yet, the impact of sex differences and public vs. private procedural setting on TAVI outcomes remain uncertain.
The RIBAC-NT (Brazilian Registry for Evaluation of Transcatheter Aortic Valve Replacement Outcomes) dataset included 3194 TAVI patients from 2009 to 2021. This retrospective analysis explored disparities in baseline characteristics, procedural and in-hospital outcomes stratifying patients by sex and procedural setting. Temporal trends were also investigated.
We included 1551 (49 %) female and 1643 (51 %) male patients. Women were older (83 [78–87] vs. 81 [75–85] years; p < 0.01) but had a lower prevalence of diabetes mellitus (30.2 % vs. 36.3 %, p < 0.01) and coronary artery disease (39.0 % vs. 52.2 %, p < 0.01). However, women had a 3-fold higher higher risk of life-threatening bleeding (6.1 % vs. 2.4 %, p < 0.01). Women presented higher procedural and in-hospital mortality rates (4.4 % vs. 2.5 % and 7.7 % vs. 4.5 %, all p < 0.01, respectively). Although public hospitals presented ~2-fold higher procedural mortality rate compared with private settings (5.0 % vs. 2.7 %, p < 0.01), after multivariable analysis procedural setting was not independently associated with in-hospital mortality.
Women had higher procedural and in-hospital mortality rates after TAVI as compared with men, while facing higher life-threatening bleeding and adverse events rates. Although public hospitals exhibited higher mortality rates than private centers, procedural setting was not independently associated with in-hospital mortality.
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•TAVI is the preferred option for aortic, but outcomes vary by sex, procedural setting, and social determinants.•Women had similar stroke, pacemaker, and MI rates as men but faced a 3-fold higher risk of life-threatening bleeding.•TAVI practices in Brazil show disparities, with public hospitals facing more vascular complications and adverse outcomes.•TAVI use has risen over the past decade, with mortality rates dropping, especially in women and public hospitals patients.•Our findings highlight the need to address sex-specific and healthcare settings to improve TAVI outcomes in Brazil.