Different impact of sex on baseline characteristics and major periprocedural outcomes of transcatheter and surgical aortic valve interventions: Results of the multicenter Italian OBSERVANT Registry
Background Despite the widespread use of transcatheter aortic valve implantation (TAVI), the role of sex on outcome after TAVI or surgical aortic valve replacement (AVR) has been poorly investigated. We investigated the impact of sex on outcome after TAVI or AVR. Methods There were 2108 patients und...
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| creator | Onorati, Francesco, MD, PhD D’Errigo, Paola, MS Barbanti, Marco, MD Rosato, Stefano, MS Covello, Remo Daniel, MD Maraschini, Alice, MS Ranucci, Marco, MD Santoro, Gennaro, MD Tamburino, Corrado, MD Grossi, Claudio, MD Santini, Francesco, MD Menicanti, Lorenzo, MD Seccareccia, Fulvia, MS |
| description | Background Despite the widespread use of transcatheter aortic valve implantation (TAVI), the role of sex on outcome after TAVI or surgical aortic valve replacement (AVR) has been poorly investigated. We investigated the impact of sex on outcome after TAVI or AVR. Methods There were 2108 patients undergoing TAVI or AVR who were enrolled in the Italian Observational Multicenter Registry (OBSERVANT). Thirty-day mortality, major periprocedural morbidity, and transprosthetic gradients were stratified by sex according to interventions. Results Female AVR patients showed a worse risk profile compared with male AVR patients, given the higher mean age, prevalence of frailty score of 2 or higher, New York Heart Association class of 3 or higher, lower body weight, and preoperative hemoglobin level ( P ≤ .02). Similarly, female TAVI patients had a different risk profile than male TAVI patients, given a higher age and a lower body weight and preoperative hemoglobin level ( P ≤ .005), but with a similar New York Heart Association class, frailty score, EuroSCORE ( P = NS), a better left ventricular ejection fraction and a lower prevalence of left ventricular ejection fraction less than 30%, porcelain aorta, renal dysfunction, chronic obstructive pulmonary disease, arteriopathy, and previous cardiovascular surgery or percutaneous coronary intervention ( P ≤ .01). Women showed a smaller aortic annulus than men in both populations ( P |
| doi_str_mv | 10.1016/j.jtcvs.2013.05.039 |
| format | Article |
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We investigated the impact of sex on outcome after TAVI or AVR. Methods There were 2108 patients undergoing TAVI or AVR who were enrolled in the Italian Observational Multicenter Registry (OBSERVANT). Thirty-day mortality, major periprocedural morbidity, and transprosthetic gradients were stratified by sex according to interventions. Results Female AVR patients showed a worse risk profile compared with male AVR patients, given the higher mean age, prevalence of frailty score of 2 or higher, New York Heart Association class of 3 or higher, lower body weight, and preoperative hemoglobin level ( P ≤ .02). Similarly, female TAVI patients had a different risk profile than male TAVI patients, given a higher age and a lower body weight and preoperative hemoglobin level ( P ≤ .005), but with a similar New York Heart Association class, frailty score, EuroSCORE ( P = NS), a better left ventricular ejection fraction and a lower prevalence of left ventricular ejection fraction less than 30%, porcelain aorta, renal dysfunction, chronic obstructive pulmonary disease, arteriopathy, and previous cardiovascular surgery or percutaneous coronary intervention ( P ≤ .01). Women showed a smaller aortic annulus than men in both populations ( P < .001). Female sex was an independent predictor in the AVR population for risk-adjusted 30-day mortality (odds ratio [OR], 2.34; P = .043) and transfusions (OR, 1.47; P = .003), but not for risk-adjusted acute myocardial infarction, stroke, vascular complications, permanent atrioventricular block ( P = NS). Female sex was an independent predictor in the TAVI population for risk-adjusted major vascular complications (OR, 2.92; P = .018) and transfusions (OR, 1.93; P = .003), but proved protective against moderate to severe postprocedural aortic insufficiency ( P = .018). Conclusions Female sex is a risk factor for mortality after aortic valve replacement, for major vascular complications after TAVI, and for transfusions after both approaches.</description><identifier>ISSN: 0022-5223</identifier><identifier>EISSN: 1097-685X</identifier><identifier>DOI: 10.1016/j.jtcvs.2013.05.039</identifier><identifier>PMID: 23856202</identifier><language>eng</language><publisher>United States: Mosby, Inc</publisher><subject>Age Factors ; Aged ; Aged, 80 and over ; Aortic Valve - surgery ; Aortic Valve Stenosis - diagnosis ; Aortic Valve Stenosis - mortality ; Aortic Valve Stenosis - surgery ; Aortic Valve Stenosis - therapy ; Blood Transfusion ; Cardiac Catheterization - adverse effects ; Cardiac Catheterization - mortality ; Cardiothoracic Surgery ; Chi-Square Distribution ; Comorbidity ; Female ; Health Status Disparities ; Heart Valve Prosthesis Implantation - adverse effects ; Heart Valve Prosthesis Implantation - methods ; Heart Valve Prosthesis Implantation - mortality ; Hospital Mortality ; Humans ; Italy ; Linear Models ; Logistic Models ; Male ; Multivariate Analysis ; Odds Ratio ; Postoperative Complications - mortality ; Postoperative Complications - therapy ; Prospective Studies ; Registries ; Risk Assessment ; Risk Factors ; Severity of Illness Index ; Sex Factors ; Time Factors ; Treatment Outcome</subject><ispartof>The Journal of thoracic and cardiovascular surgery, 2014-05, Vol.147 (5), p.1529-1539</ispartof><rights>The American Association for Thoracic Surgery</rights><rights>2014 The American Association for Thoracic Surgery</rights><rights>Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c459t-8802471c1ada4672fe2d2231bd6a6b1704ff9e7bf564e4a81963d4335466bc353</citedby><cites>FETCH-LOGICAL-c459t-8802471c1ada4672fe2d2231bd6a6b1704ff9e7bf564e4a81963d4335466bc353</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0022522313006041$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23856202$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Onorati, Francesco, MD, PhD</creatorcontrib><creatorcontrib>D’Errigo, Paola, MS</creatorcontrib><creatorcontrib>Barbanti, Marco, MD</creatorcontrib><creatorcontrib>Rosato, Stefano, MS</creatorcontrib><creatorcontrib>Covello, Remo Daniel, MD</creatorcontrib><creatorcontrib>Maraschini, Alice, MS</creatorcontrib><creatorcontrib>Ranucci, Marco, MD</creatorcontrib><creatorcontrib>Santoro, Gennaro, MD</creatorcontrib><creatorcontrib>Tamburino, Corrado, MD</creatorcontrib><creatorcontrib>Grossi, Claudio, MD</creatorcontrib><creatorcontrib>Santini, Francesco, MD</creatorcontrib><creatorcontrib>Menicanti, Lorenzo, MD</creatorcontrib><creatorcontrib>Seccareccia, Fulvia, MS</creatorcontrib><creatorcontrib>OBSERVANT Research Group</creatorcontrib><title>Different impact of sex on baseline characteristics and major periprocedural outcomes of transcatheter and surgical aortic valve interventions: Results of the multicenter Italian OBSERVANT Registry</title><title>The Journal of thoracic and cardiovascular surgery</title><addtitle>J Thorac Cardiovasc Surg</addtitle><description>Background Despite the widespread use of transcatheter aortic valve implantation (TAVI), the role of sex on outcome after TAVI or surgical aortic valve replacement (AVR) has been poorly investigated. We investigated the impact of sex on outcome after TAVI or AVR. Methods There were 2108 patients undergoing TAVI or AVR who were enrolled in the Italian Observational Multicenter Registry (OBSERVANT). Thirty-day mortality, major periprocedural morbidity, and transprosthetic gradients were stratified by sex according to interventions. Results Female AVR patients showed a worse risk profile compared with male AVR patients, given the higher mean age, prevalence of frailty score of 2 or higher, New York Heart Association class of 3 or higher, lower body weight, and preoperative hemoglobin level ( P ≤ .02). Similarly, female TAVI patients had a different risk profile than male TAVI patients, given a higher age and a lower body weight and preoperative hemoglobin level ( P ≤ .005), but with a similar New York Heart Association class, frailty score, EuroSCORE ( P = NS), a better left ventricular ejection fraction and a lower prevalence of left ventricular ejection fraction less than 30%, porcelain aorta, renal dysfunction, chronic obstructive pulmonary disease, arteriopathy, and previous cardiovascular surgery or percutaneous coronary intervention ( P ≤ .01). Women showed a smaller aortic annulus than men in both populations ( P < .001). Female sex was an independent predictor in the AVR population for risk-adjusted 30-day mortality (odds ratio [OR], 2.34; P = .043) and transfusions (OR, 1.47; P = .003), but not for risk-adjusted acute myocardial infarction, stroke, vascular complications, permanent atrioventricular block ( P = NS). Female sex was an independent predictor in the TAVI population for risk-adjusted major vascular complications (OR, 2.92; P = .018) and transfusions (OR, 1.93; P = .003), but proved protective against moderate to severe postprocedural aortic insufficiency ( P = .018). Conclusions Female sex is a risk factor for mortality after aortic valve replacement, for major vascular complications after TAVI, and for transfusions after both approaches.</description><subject>Age Factors</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Aortic Valve - surgery</subject><subject>Aortic Valve Stenosis - diagnosis</subject><subject>Aortic Valve Stenosis - mortality</subject><subject>Aortic Valve Stenosis - surgery</subject><subject>Aortic Valve Stenosis - therapy</subject><subject>Blood Transfusion</subject><subject>Cardiac Catheterization - adverse effects</subject><subject>Cardiac Catheterization - mortality</subject><subject>Cardiothoracic Surgery</subject><subject>Chi-Square Distribution</subject><subject>Comorbidity</subject><subject>Female</subject><subject>Health Status Disparities</subject><subject>Heart Valve Prosthesis Implantation - adverse effects</subject><subject>Heart Valve Prosthesis Implantation - methods</subject><subject>Heart Valve Prosthesis Implantation - mortality</subject><subject>Hospital Mortality</subject><subject>Humans</subject><subject>Italy</subject><subject>Linear Models</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Multivariate Analysis</subject><subject>Odds Ratio</subject><subject>Postoperative Complications - mortality</subject><subject>Postoperative Complications - therapy</subject><subject>Prospective Studies</subject><subject>Registries</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Severity of Illness Index</subject><subject>Sex Factors</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>0022-5223</issn><issn>1097-685X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFks1u1DAUhSMEokPhCZCQl2wmXNuJkyCBVEqBShWV2oLYWY5z03FI7MF2RswD8l44ncKCDSvLvufcv89Z9pxCToGKV0M-RL0LOQPKcyhz4M2DbEWhqdaiLr89zFYAjK1LxvhR9iSEAQAqoM3j7IjxuhQM2Cr79d70PXq0kZhpq3QkricBfxJnSasCjsYi0RvlUwi9CdHoQJTtyKQG58k2vW2909jNXo3EzVG7CcOSJHplg1Zxg8l4ZwmzvzU6yZTzKQ_ZqXGHxNgU36UGjLPhNbnCMI_xkGGDZEoXo3HRkPOoRqMsuXx3fXb19eTzTRLfppb8_mn2qFdjwGf353H25cPZzemn9cXlx_PTk4u1LsomrusaWFFRTVWnClGxHlmXtkPbTijR0gqKvm-wavtSFFiomjaCdwXnZSFEq3nJj7OXh7xp5h8zhignEzSOo7Lo5iBpySgvoKxFkvKDVHsXgsdebr2ZlN9LCnLhJwd5x08u_CSUMvFLrhf3BeZ2wu6v5w-wJHhzEGAac2fQy6AN2gTAeNRRds78p8Dbf_w6IV6ofMc9hsHN3qYNSioDkyCvly-0_CDKAQQUlP8Gh6LGxQ</recordid><startdate>20140501</startdate><enddate>20140501</enddate><creator>Onorati, Francesco, MD, PhD</creator><creator>D’Errigo, Paola, MS</creator><creator>Barbanti, Marco, MD</creator><creator>Rosato, Stefano, MS</creator><creator>Covello, Remo Daniel, MD</creator><creator>Maraschini, Alice, MS</creator><creator>Ranucci, Marco, MD</creator><creator>Santoro, Gennaro, MD</creator><creator>Tamburino, Corrado, MD</creator><creator>Grossi, Claudio, MD</creator><creator>Santini, Francesco, MD</creator><creator>Menicanti, Lorenzo, MD</creator><creator>Seccareccia, Fulvia, MS</creator><general>Mosby, Inc</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20140501</creationdate><title>Different impact of sex on baseline characteristics and major periprocedural outcomes of transcatheter and surgical aortic valve interventions: Results of the multicenter Italian OBSERVANT Registry</title><author>Onorati, Francesco, MD, PhD ; D’Errigo, Paola, MS ; Barbanti, Marco, MD ; Rosato, Stefano, MS ; Covello, Remo Daniel, MD ; Maraschini, Alice, MS ; Ranucci, Marco, MD ; Santoro, Gennaro, MD ; Tamburino, Corrado, MD ; Grossi, Claudio, MD ; Santini, Francesco, MD ; Menicanti, Lorenzo, MD ; Seccareccia, Fulvia, MS</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c459t-8802471c1ada4672fe2d2231bd6a6b1704ff9e7bf564e4a81963d4335466bc353</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Age Factors</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Aortic Valve - surgery</topic><topic>Aortic Valve Stenosis - diagnosis</topic><topic>Aortic Valve Stenosis - mortality</topic><topic>Aortic Valve Stenosis - surgery</topic><topic>Aortic Valve Stenosis - therapy</topic><topic>Blood Transfusion</topic><topic>Cardiac Catheterization - adverse effects</topic><topic>Cardiac Catheterization - mortality</topic><topic>Cardiothoracic Surgery</topic><topic>Chi-Square Distribution</topic><topic>Comorbidity</topic><topic>Female</topic><topic>Health Status Disparities</topic><topic>Heart Valve Prosthesis Implantation - adverse effects</topic><topic>Heart Valve Prosthesis Implantation - methods</topic><topic>Heart Valve Prosthesis Implantation - mortality</topic><topic>Hospital Mortality</topic><topic>Humans</topic><topic>Italy</topic><topic>Linear Models</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Multivariate Analysis</topic><topic>Odds Ratio</topic><topic>Postoperative Complications - mortality</topic><topic>Postoperative Complications - therapy</topic><topic>Prospective Studies</topic><topic>Registries</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Severity of Illness Index</topic><topic>Sex Factors</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Onorati, Francesco, MD, PhD</creatorcontrib><creatorcontrib>D’Errigo, Paola, MS</creatorcontrib><creatorcontrib>Barbanti, Marco, MD</creatorcontrib><creatorcontrib>Rosato, Stefano, MS</creatorcontrib><creatorcontrib>Covello, Remo Daniel, MD</creatorcontrib><creatorcontrib>Maraschini, Alice, MS</creatorcontrib><creatorcontrib>Ranucci, Marco, MD</creatorcontrib><creatorcontrib>Santoro, Gennaro, MD</creatorcontrib><creatorcontrib>Tamburino, Corrado, MD</creatorcontrib><creatorcontrib>Grossi, Claudio, MD</creatorcontrib><creatorcontrib>Santini, Francesco, MD</creatorcontrib><creatorcontrib>Menicanti, Lorenzo, MD</creatorcontrib><creatorcontrib>Seccareccia, Fulvia, MS</creatorcontrib><creatorcontrib>OBSERVANT Research Group</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Onorati, Francesco, MD, PhD</au><au>D’Errigo, Paola, MS</au><au>Barbanti, Marco, MD</au><au>Rosato, Stefano, MS</au><au>Covello, Remo Daniel, MD</au><au>Maraschini, Alice, MS</au><au>Ranucci, Marco, MD</au><au>Santoro, Gennaro, MD</au><au>Tamburino, Corrado, MD</au><au>Grossi, Claudio, MD</au><au>Santini, Francesco, MD</au><au>Menicanti, Lorenzo, MD</au><au>Seccareccia, Fulvia, MS</au><aucorp>OBSERVANT Research Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Different impact of sex on baseline characteristics and major periprocedural outcomes of transcatheter and surgical aortic valve interventions: Results of the multicenter Italian OBSERVANT Registry</atitle><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle><addtitle>J Thorac Cardiovasc Surg</addtitle><date>2014-05-01</date><risdate>2014</risdate><volume>147</volume><issue>5</issue><spage>1529</spage><epage>1539</epage><pages>1529-1539</pages><issn>0022-5223</issn><eissn>1097-685X</eissn><abstract>Background Despite the widespread use of transcatheter aortic valve implantation (TAVI), the role of sex on outcome after TAVI or surgical aortic valve replacement (AVR) has been poorly investigated. We investigated the impact of sex on outcome after TAVI or AVR. Methods There were 2108 patients undergoing TAVI or AVR who were enrolled in the Italian Observational Multicenter Registry (OBSERVANT). Thirty-day mortality, major periprocedural morbidity, and transprosthetic gradients were stratified by sex according to interventions. Results Female AVR patients showed a worse risk profile compared with male AVR patients, given the higher mean age, prevalence of frailty score of 2 or higher, New York Heart Association class of 3 or higher, lower body weight, and preoperative hemoglobin level ( P ≤ .02). Similarly, female TAVI patients had a different risk profile than male TAVI patients, given a higher age and a lower body weight and preoperative hemoglobin level ( P ≤ .005), but with a similar New York Heart Association class, frailty score, EuroSCORE ( P = NS), a better left ventricular ejection fraction and a lower prevalence of left ventricular ejection fraction less than 30%, porcelain aorta, renal dysfunction, chronic obstructive pulmonary disease, arteriopathy, and previous cardiovascular surgery or percutaneous coronary intervention ( P ≤ .01). Women showed a smaller aortic annulus than men in both populations ( P < .001). Female sex was an independent predictor in the AVR population for risk-adjusted 30-day mortality (odds ratio [OR], 2.34; P = .043) and transfusions (OR, 1.47; P = .003), but not for risk-adjusted acute myocardial infarction, stroke, vascular complications, permanent atrioventricular block ( P = NS). Female sex was an independent predictor in the TAVI population for risk-adjusted major vascular complications (OR, 2.92; P = .018) and transfusions (OR, 1.93; P = .003), but proved protective against moderate to severe postprocedural aortic insufficiency ( P = .018). Conclusions Female sex is a risk factor for mortality after aortic valve replacement, for major vascular complications after TAVI, and for transfusions after both approaches.</abstract><cop>United States</cop><pub>Mosby, Inc</pub><pmid>23856202</pmid><doi>10.1016/j.jtcvs.2013.05.039</doi><tpages>11</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Age Factors Aged Aged, 80 and over Aortic Valve - surgery Aortic Valve Stenosis - diagnosis Aortic Valve Stenosis - mortality Aortic Valve Stenosis - surgery Aortic Valve Stenosis - therapy Blood Transfusion Cardiac Catheterization - adverse effects Cardiac Catheterization - mortality Cardiothoracic Surgery Chi-Square Distribution Comorbidity Female Health Status Disparities Heart Valve Prosthesis Implantation - adverse effects Heart Valve Prosthesis Implantation - methods Heart Valve Prosthesis Implantation - mortality Hospital Mortality Humans Italy Linear Models Logistic Models Male Multivariate Analysis Odds Ratio Postoperative Complications - mortality Postoperative Complications - therapy Prospective Studies Registries Risk Assessment Risk Factors Severity of Illness Index Sex Factors Time Factors Treatment Outcome |
| title | Different impact of sex on baseline characteristics and major periprocedural outcomes of transcatheter and surgical aortic valve interventions: Results of the multicenter Italian OBSERVANT Registry |
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