Impact of Gender on Three-Month Outcome and Left Ventricular Remodeling After Transfemoral Transcatheter Aortic Valve Implantation

• Published in: The American journal of cardiology Vol. 110; no. 6; pp. 884 - 890
• Main Authors: Stangl, Verena, MD, Baldenhofer, Gerd, MD, Knebel, Fabian, MD, Zhang, Kun, MD, Sanad, Wasiem, MD, Spethmann, Sebastian, MD, Grubitzsch, Herko, MD, Sander, Michael, MD, Wernecke, Klaus-Dieter, MD, Baumann, Gert, MD, Stangl, Karl, MD, Laule, Michael, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 15-09-2012; Elsevier; Elsevier Limited
• Subjects: Aged; Aortic Valve - surgery; Aortic Valve Stenosis - mortality; Aortic Valve Stenosis - pathology; Aortic Valve Stenosis - physiopathology; Aortic Valve Stenosis - surgery; Biological and medical sciences; Cardiac Catheterization; Cardiology; Cardiology. Vascular system; Cardiovascular; Cardiovascular disease; Echocardiography; Female; Gender differences; Heart Valve Prosthesis Implantation - methods; Humans; Male; Medical sciences; Mortality; Postoperative Complications; Risk Factors; Sex Factors; Studies; Survival Rate; Treatment Outcome; Ventricular Remodeling; Germany; Vascular remodeling; Prognosis; Sex; Implantation; Circulatory system; Cardiology; Aortic valve; Left ventricle
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2012.04.063

Transarterial aortic valve implantation (TAVI) is a promising method for the treatment of high-risk patients with aortic stenosis. Because gender differences are known in aortic stenosis, the aim of this study was to compare procedural and short-term outcomes, left ventricular remodeling, and inflammatory status after TAVI in men and women. One hundred consecutive patients (42 men, 58 women) who underwent transfemoral TAVI (CoreValve in 83%, SAPIEN in 17%) were prospectively analyzed. Aortic stenosis severity was higher in women (mean valve area 0.7 ± 0.3 vs 0.8 ± 0.2 cm2 ). Women had better ejection fractions, smaller end-diastolic and end-systolic diameters, and more concentric hypertrophy at baseline. There were no differences in device success rate (99%), 30-day total mortality (2.4% in men, 3.4% in women), stroke (2.4% in men, 1.7% in women), or pacemaker rate (26.2% in men, 15.5% in women). Periprocedural complications and 3-month outcome were not different between the genders. After TAVI, regression of hypertrophy occurred in men and women, but improvement of the ejection fraction was significant only in women. N-terminal pro–B-type natriuretic peptide decreased to similar levels in the 2 genders. C-reactive protein and interleukin-6, elevated at baseline more in men than in women, decreased after TAVI and normalized at 3 months only in women. In conclusion, women clinically benefit from TAVI to a degree similar to that of men. However, there are gender differences involving the recovery response of the left ventricle after TAVI.