Background:
It is well known that there is a significant gender gap in both the referral and outcomes of patients eligible for cardiac surgery. The impact of transcatheter aortic valve replacement (TAVR) on the gender disparity in the management of aortic stenosis (AS) has not been well established. The aim of this study was to analyze the referrals to and outcomes of both surgical aortic valve replacement (SAVR) and TAVR for management of AS as a function of gender in a contemporary United States population.
Methods:
We used the National Inpatient database 2009-2015 to study the gender distribution of admissions for both SAVR and TAVR for the treatment of AS and its effect on inpatient outcomes. The survey estimation commands were used to determine weighted national estimates.
Results:
During the study period there were 3,443,274 (Males (M) 46.6 ± 0.1%; Females (F) 53.3 ± 0.1%) admissions for AS diagnosis, 325,264 SAVR (M 62.0 ± 0.2%; F 37.9 ± 0.2%) and 56,542 TAVR (M 52.6 ± 0.5%; F 47.3 ± 0.5%). The gender disparity was more prominent in Whites (Wh) than Non-whites (NWh) for both SAVR (Wh M 62.7 ± 0.2%, Wh F 37.2 ± 0.2%; NWh M 57.3 ± 0.5%, NWF 42.6 ± 0.5%) and TAVR (Wh M 53.1 ± 0.5%, Wh F 46.8 ± 0.5%; NWh M 47.2 ± 1.3%, NWh F 52.7 ± 1.3%). Female TAVR patients were older and more likely to have Medicare but less likely to have diabetes, chronic kidney disease (CKD), peripheral artery disease (PAD), prior coronary bypass surgery (CABG) and percutaneous coronary intervention (PCI), and chronic obstructive pulmonary disease (COPD). They also had lower Charlson comorbidity index (CCI). However, female TAVR patients had higher inpatient deaths (OR = 1.34;1.09-1.64), bleeding (OR = 1.51; 1.40-1.62) and stroke (OR = 1.47; 1.16-1.88), but a lower rate of pacemaker implantation (0.86; 0.76-0.97) and acute renal failure (ARF) (OR = 0.78; 0.71- 0.87). SAVR females were older, more likely to have Medicare, hypertension, and heart failure but less likely to have diabetes, CKD, PAD, prior CABG and PCI, and COPD. They also had lower CCI. SAVR female patients had higher inpatient deaths (OR = 1.40; 1.29-1.53), pacemaker implantation (OR =1.19; 1.11-1.28), blood transfusion (OR = 1.40; 1.35-1.45), and stroke (OR =1.19; 1.08-1.30), but lower ARF (OR = 0.80; 0.76-0.83).
Conclusion:
A gender disparity in the management of aortic stenosis continues to exist; however, our study showed that TAVR appears to bridge this gap. The reduction in gender disparity was most pronounced among Non-white patients. Despite having less comorbidities, outcomes after both SAVR and TAVR remain worse in women.
Antithrombotic Therapy after Bioprosthetic Aortic Valve Replacement: A Therapeutic Morass
