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Clinical Cardiology Journal

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Gender-related differences in outcomes of transcatheter aortic valve replacement in nonagenarians

Author(s): Darren C Tsang, Marcos Nores, Mark Rothenberg, Larry Lovitz, Cristiano Faber and Sotiris C. Stamou*

Background: Multiple studies suggest women have lower intermediate-term mortality risk than men following transcatheter aortic valve replacement, yet no published investigations have evaluated this trend in nonagenarians.

Objective: We compare early clinical outcomes and actuarial survival of nonagenarians who underwent transcatheter aortic valve replacement, by gender.

Methods: A concurrent cohort study of 148 consecutive nonagenarians undergoing transcatheter aortic valve replacement from April 2012 to July 2017 was conducted at a tertiary referral center. Relevant baseline demographics between men and women were compared. Major morbidity, operative mortality, and 5-year actuarial survival were compared between groups. Independent predictors of operative and late mortality were examined.

Results: Compared with men, women presented with higher STS risk scores (women: 7.2% [5.9-8.8%] vs. men: 5.8 [3.8-7.5%]; p=0.002). Women experienced more postoperative atrial fibrillation compared with men (women: 20% vs. men: 9%; p=0.049). Overall operative mortality was similar between groups (women: 4% vs. men: 10%; p=0.181). Actuarial survival at 3 and 5-years was lower in women than men, but this difference did not reach statistical significance (69% and 56% for women, and 58% and 40% for men, respectively; p=0.071). Urgent status was associated with increased risk of operative mortality. Predictors of late mortality included urgent status, coronary artery disease, history of atrial fibrillation, and postoperative prolonged ventilatory support, stroke, cardiac arrest, and pacemaker implantation.

Conclusion: Significant gender-related differences exist in nonagenarians presenting for transcatheter aortic valve replacement. While women had lower operative and late mortality, actuarial survival did not achieve statistical significance at 3 and 5-years.

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