The Impact of Gender on Outcomes Following Transcatheter Aortic Valve Implantation: True Effect or Bias?
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Vasileios F. Panoulas1,2,5, Neil Ruparelia1,2, Russel Franks2, Sayan Sen1,2, Ben Ariff3, Nilesh Sutaria1,2, Angela Frame2, Petros Nihoyannopoulos1,2, Iqbal S. Malik1,2, Ghada W. Mikhail1,2 1Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK2Cardiology Department, National Heart and Lung Institute, Imperial College London, London, UK 3Radiology Department, National Heart and Lung Institute, Imperial College London, London, UK 4Department of Cardiothoracic Surgery, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK 5Electronic correspondence: v.panoulas@imperial.ac.uk |
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Transcatheter aortic valve implantation (TAVI) is currently the treatment of choice for patients with severe aortic stenosis (AS) who are unsuitable for surgical aortic valve replacement (SAVR), and is an acceptable alternative for those at high and intermediate surgical risk. In published TAVI registries and meta-analyses, whilst women are significantly older they present with fewer comorbidities compared to men (including coronary artery disease, peripheral vascular disease, diabetes and chronic obstructive pulmonary disease). In response to chronic pressure overload from AS, women have been shown to develop greater levels of left ventricular hypertrophy than
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men, as well as having a greater preservation of LV ejection fraction (LVEF) and less fibrosis. Following aortic valve replacement, women have been shown to have a faster regression of myocardial hypertrophy, with a significant improvement in LVEF. Following TAVI, female gender seems to be associated with a significantly lower one-year mortality. In the current viewpoint, it is discussed whether these findings reflect a true differential treatment response to TAVI among women, or simply the higher comorbidity burden among males undergoing TAVI The Journal of Heart Valve Disease 2016;25:552-556 |
| The Impact of Gender on Outcomes Following Transcatheter Aortic Valve Implantation: True Effect or Bias? | |
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