Key result
Female patients undergoing surgical aortic valve replacement had higher 30-day mortality than men, whereas those undergoing transcatheter replacement had similar 30-day and better long-term survival.
Why the study?
SAVR is associated with an elevated risk for women compared to men, unlike TAVR, prompting a review to better understand the risks and possible causes associated with both procedures in female patients.
Are there gender differences in short- and long-term mortality outcomes following SAVR and TAVR for aortic stenosis?
Systematic Review
Are there gender differences in short- and long-term mortality outcomes following SAVR and TAVR for aortic stenosis?
Women face higher short-term mortality risks with SAVR compared to men, but have similar short-term and better long-term survival with TAVR, suggesting TAVR may be a safer option for female patients.
Favors TAVR over SAVR in women with aortic stenosis; extends sex-specific outcome data from prior valve trials.
Aortic stenosis (AS) is a progressive and degenerative disease that necessitates valve replacement through either surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR). Various studies have shown that, unlike for TAVR, SAVR is associated with an elevated risk for women as compared to men. The aim of this review is to better understand the risks and their possible causes, associated with the use of both TAVR and SAVR in female patients. Our systematic review included studies published between 2012 and 2020, identified through specific searches of PubMed. Compatibility of publications, determined by the use of pre-defined inclusion/exclusion criteria, resulted in 15 articles being used in our review. Overall, more men than women undergo SAVR, but our findings confirmed that SAVR is associated with worse outcomes in women in the short-term. Reasons for a higher 30-day mortality post-SAVR in women include an increased age, higher in-hospital mortality and, possibly baseline comorbidities and anatomical differences. There was no difference observed in 30-day mortality between men and women undergoing TAVR. Female patients appear to have a better longer-term survival post-TAVR than their male counterparts. Understanding the reasons why women have worse outcomes post-SAVR is essential for ensuring appropriate treatment selection for patients with AS, as well as for achieving the best possible long-term and safety outcomes for these patients.
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Caponcello et al. (2020) conducted a systematic review in Aortic stenosis. Female gender vs. Male gender was evaluated on 30-day mortality and long-term survival. Female patients undergoing surgical aortic valve replacement had higher 30-day mortality than men, whereas those undergoing transcatheter replacement had similar 30-day and better long-term survival.
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