Medizinische Klinik mit Schwerpunkt Kardiologie und Angiologie, Charité Campus Mitte, Universitätsmedizin Berlin, Germany.
Am J Cardiol. 2012 Sep 15;110(6):884-90. doi: 10.1016/j.amjcard.2012.04.063. Epub 2012 Jun 2.
Transarterial aortic valve implantation (TAVI) is a promising method for the treatment of high-risk patients with aortic stenosis. Because gender differences are known in aortic stenosis, the aim of this study was to compare procedural and short-term outcomes, left ventricular remodeling, and inflammatory status after TAVI in men and women. One hundred consecutive patients (42 men, 58 women) who underwent transfemoral TAVI (CoreValve in 83%, SAPIEN in 17%) were prospectively analyzed. Aortic stenosis severity was higher in women (mean valve area 0.7 ± 0.3 vs 0.8 ± 0.2 cm(2)). Women had better ejection fractions, smaller end-diastolic and end-systolic diameters, and more concentric hypertrophy at baseline. There were no differences in device success rate (99%), 30-day total mortality (2.4% in men, 3.4% in women), stroke (2.4% in men, 1.7% in women), or pacemaker rate (26.2% in men, 15.5% in women). Periprocedural complications and 3-month outcome were not different between the genders. After TAVI, regression of hypertrophy occurred in men and women, but improvement of the ejection fraction was significant only in women. N-terminal pro-B-type natriuretic peptide decreased to similar levels in the 2 genders. C-reactive protein and interleukin-6, elevated at baseline more in men than in women, decreased after TAVI and normalized at 3 months only in women. In conclusion, women clinically benefit from TAVI to a degree similar to that of men. However, there are gender differences involving the recovery response of the left ventricle after TAVI.
经导管主动脉瓣植入术（TAVI）是治疗高危主动脉瓣狭窄患者的一种有前途的方法。由于主动脉瓣狭窄存在性别差异，因此本研究旨在比较男性和女性经股动脉 TAVI（CoreValve 占 83%，SAPIEN 占 17%）后的手术和短期结果、左心室重构和炎症状态。前瞻性分析了 100 例连续接受经股动脉 TAVI（CoreValve 占 83%，SAPIEN 占 17%）的患者（男性 42 例，女性 58 例）。女性的主动脉瓣狭窄程度更高（平均瓣口面积 0.7±0.3cm2 vs 0.8±0.2cm2）。女性的射血分数更高，舒张末期和收缩末期直径更小，基础时的向心性肥厚更多。器械成功率（男性 99%，女性 99%）、30 天总死亡率（男性 2.4%，女性 3.4%）、卒中和起搏器率（男性 2.4%，女性 1.7%）在性别之间无差异。围手术期并发症和 3 个月的结果在性别之间没有差异。TAVI 后，男性和女性的心肌肥厚均发生消退，但女性的射血分数仅显著改善。男女患者的 N 末端脑利钠肽前体（NT-proBNP）均降至相似水平。C 反应蛋白和白细胞介素-6 在基线时男性比女性升高更多，TAVI 后降低，并仅在女性中于 3 个月时恢复正常。总之，女性从 TAVI 中获益的程度与男性相似。然而，在 TAVI 后左心室恢复反应方面存在性别差异。
