Skip to main content
Journal cover image

Sex-related differences in outcomes after transcatheter or surgical aortic valve replacement in patients with severe aortic stenosis: Insights from the PARTNER Trial (Placement of Aortic Transcatheter Valve).

Publication ,  Journal Article
Williams, M; Kodali, SK; Hahn, RT; Humphries, KH; Nkomo, VT; Cohen, DJ; Douglas, PS; Mack, M; McAndrew, TC; Svensson, L; Thourani, VH ...
Published in: J Am Coll Cardiol
April 22, 2014

OBJECTIVES: This study sought to examine sex-specific differences in outcomes after surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR) in high-risk patients with severe aortic stenosis. BACKGROUND: The PARTNER (Placement of Aortic Transcatheter Valve) trial demonstrated similar 2-year survival with SAVR or TAVR for high-risk patients, but sex-specific outcomes are unknown. METHODS: In all, 699 patients (300 female) were randomly assigned 1:1 to either SAVR or TAVR with a balloon expandable pericardial tissue valve. Baseline characteristics and 2-year outcomes of TAVR versus SAVR were compared among males and females. RESULTS: Baseline characteristics differed between the sexes. Despite higher Society of Thoracic Surgeons mortality risk scores (11.9 vs. 11.6; p = 0.05), female patients had lower prevalence of coronary artery disease (64.4% vs. 83.7%), prior coronary artery bypass graft surgery (19.8% vs. 61.2%), peripheral vascular disease (36.4% vs. 46.9%), diabetes mellitus (35.6% vs. 45.6%), and elevated creatinine (11.7% vs. 23.9%). Among female patients, procedural mortality trended lower with TAVR versus SAVR (6.8% vs. 13.1%; p = 0.07) and was maintained throughout follow-up (hazard ratio [HR]: 0.67; 95% confidence interval [CI]: 0.44 to 1.00; p = 0.049), driven by the transfemoral arm (HR: 0.55; 95% CI: 0.32 to 0.93; p = 0.02). Among male patients, although procedural mortality was lower with TAVR (6% vs. 12.1%; p = 0.03), there was no overall survival benefit (HR: 1.15; 95% CI: 0.82 to 1.61; p = 0.42). CONCLUSIONS: In this retrospective subanalysis of high-risk, symptomatic aortic stenosis patients in the PARTNER trial, female subjects had lower late mortality with TAVR versus SAVR. This was especially true among patients suitable for transfemoral access and suggests that TAVR may be preferred over surgery for high-risk female patients. A randomized, controlled trial conducted specifically in female patients is necessary to properly study differences in mortality between treatment modalities. (THE PARTNER TRIAL: Placement of AoRTic TraNscathetER Valve Trial; NCT00530894).

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

April 22, 2014

Volume

63

Issue

15

Start / End Page

1522 / 1528

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Survival Rate
  • Sex Factors
  • Sex Distribution
  • Severity of Illness Index
  • Risk Factors
  • Retrospective Studies
  • Postoperative Complications
  • Male
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Williams, M., Kodali, S. K., Hahn, R. T., Humphries, K. H., Nkomo, V. T., Cohen, D. J., … Leon, M. B. (2014). Sex-related differences in outcomes after transcatheter or surgical aortic valve replacement in patients with severe aortic stenosis: Insights from the PARTNER Trial (Placement of Aortic Transcatheter Valve). J Am Coll Cardiol, 63(15), 1522–1528. https://doi.org/10.1016/j.jacc.2014.01.036
Williams, Mathew, Susheel K. Kodali, Rebecca T. Hahn, Karin H. Humphries, Vuyisile T. Nkomo, David J. Cohen, Pamela S. Douglas, et al. “Sex-related differences in outcomes after transcatheter or surgical aortic valve replacement in patients with severe aortic stenosis: Insights from the PARTNER Trial (Placement of Aortic Transcatheter Valve).J Am Coll Cardiol 63, no. 15 (April 22, 2014): 1522–28. https://doi.org/10.1016/j.jacc.2014.01.036.
Williams M, Kodali SK, Hahn RT, Humphries KH, Nkomo VT, Cohen DJ, Douglas PS, Mack M, McAndrew TC, Svensson L, Thourani VH, Tuzcu EM, Weissman NJ, Kirtane AJ, Leon MB. Sex-related differences in outcomes after transcatheter or surgical aortic valve replacement in patients with severe aortic stenosis: Insights from the PARTNER Trial (Placement of Aortic Transcatheter Valve). J Am Coll Cardiol. 2014 Apr 22;63(15):1522–1528.
Journal cover image

Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

April 22, 2014

Volume

63

Issue

15

Start / End Page

1522 / 1528

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Survival Rate
  • Sex Factors
  • Sex Distribution
  • Severity of Illness Index
  • Risk Factors
  • Retrospective Studies
  • Postoperative Complications
  • Male