Long-term Evidence Supports Better Survival for Women Than Men After TAVR

Compared with men, women have a survival advantage after TAVR that remains consistent for several years after the procedure, according to data from a meta-analysis.

The suggestion that women fare better than men after aortic valve replacement has been raised in multiple prior studies, but few have included long-term, multinational outcomes data.

“Women are receiving half of the TAVR procedures that are performed throughout the world,” said J. Dawn Abbott, MD (Rhode Island Hospital, Providence, RI), senior author of the new study published online October 18, 2017, in JACC: Cardiovascular Interventions. “We didn’t look at the mechanism for why women do better, but our study seems to suggest that procedurally they have less paravalvular leak.” Other possible explanations, she told TCTMD, may be better ventricular remodeling in women, as well as specific comorbidities in men, such as depression or mobility issues, that contribute to them having poorer survival.

Interestingly, Abbott hypothesized that if the “paravalvular leak story” is the explanation for better survival in women, it may be short-lived as newer devices come to market that reduce the complication in men. Conversely, these newer iterations also could reduce bleeding significantly in women, allowing the female survival advantage to persist, she added.

Persistent Stroke Risk for Women Confirmed

Abbott and colleagues, led by Marwan Saad, MD, PhD (University of Arkansas for Medical Sciences, Little Rock, AR), analyzed 17 studies of TAVR patients that were published between 2012 and 2017. Of the 47,188 patients, approximately half were women.

Compared with men, women had more major bleeding in the first 30 days, as well as more vascular complications and stroke/TIA. Although rates of all-cause and cardiovascular mortality at 30 days showed no gender differences, women had lower all-cause mortality at both 1 year (RR 0.85; 95% CI 0.79-0.91) and 3.2 years (RR 0.86; 95% CI 0.81-0.92).

Compared with men, women were less likely to have moderate/severe aortic insufficiency (4.4% vs 6.1%; P = 0.001) or permanent pacemaker placement after the procedure. Long-term, women also had a 20% lower cardiovascular mortality rate than men, despite a 23% higher risk of stroke.

“Previous studies showed that the short-term risk of stroke was higher in women,” said Abbott. “But this new study is the first to report that the late risk of stroke also is higher in women out to 1 year. That needs some further investigation. It may be related to higher risk of later A-fib, hypertension, or other causes of stroke that are unclear . . . but I think we need to pay closer attention to stroke risk in women and not assume they are all procedure-related.”

Photo Credit: Captured from TVT 2016: Live Case #13: TAVR. McGill University Health Center, Royal Victoria Hospital, Montreal, Quebec. June 17, 2016.