Key result
Female sex was independently associated with a 38.5% reduction in cumulative long-term all-cause mortality (HR 0.615) compared to male sex after transcatheter aortic valve implantation.
Why the study?
The effect of sex on mortality is controversial and sex differences in LV remodeling after TAVI remain unknown.
Does female sex improve survival and affect left ventricular remodeling after transcatheter aortic valve implantation?
Observational (n=2,588)
Yes
Does female sex improve survival and affect left ventricular remodeling after transcatheter aortic valve implantation?
Female sex is independently associated with lower long-term mortality after TAVI, with survival advantages particularly evident in patients experiencing left ventricular mass regression at 1 year.
Hypothesis-generating for female survival advantage after TAVI; prospective studies needed to clarify remodeling effects and guide practice.
BACKGROUND: The effect of sex on mortality is controversial; furthermore, sex differences in left ventricular (LV) remodeling after transcatheter aortic valve implantation (TAVI) remain unknown. METHODS AND RESULTS: This study included 2,588 patients (1,793 [69.3%] female) enrolled in the Optimized CathEter vAlvular iNtervention (OCEAN)-TAVI Japanese multicenter registry between October 2013 and May 2017. We retrospectively analyzed the effect of sex on mortality, and evaluated changes in the LV mass index (LVMI) after TAVI. Female sex was significantly associated with lower all-cause and cardiovascular mortality (log-rank P<0.001 for both). Multivariate analysis showed that female sex was independently associated with lower cumulative long-term mortality (hazard ratio 0.615; 95% confidence interval 0.512-0.738; P<0.001). Regression in the LVMI was observed in both sexes, and there was no significant difference in the percentage LVMI regression from baseline to 1 year after TAVI between women and men. Women had a survival advantage compared with men among patients with LVMI regression at 1 year, but not among patients with no LVMI regression. CONCLUSIONS: We found that female sex is associated with better survival outcomes after TAVI in a large Japanese registry. Although LVMI regression was observed in women and men after TAVI, post-procedural LV mass regression may be related to the sex differences in mortality.
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Shishido et al. (2021) conducted an observational in Severe aortic stenosis (n=2,588). Female sex vs. Male sex was evaluated on Cumulative long-term all-cause mortality (HR 0.615, 95% CI 0.512-0.738, p=<0.001). Female sex was independently associated with a 38.5% reduction in cumulative long-term all-cause mortality (HR 0.615) compared to male sex after transcatheter aortic valve implantation.
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