Caponcello Maria Giulia, Banderas Lucia M, Ferrero Carmen, Bramlage Carsten, Thoenes Martin, Bramlage Peter
Departamento Farmacia y Tecnología Farmacéutica, Universidad de Sevilla, Sevilla, Spain.
Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany.
J Thorac Dis. 2020 Jul;12(7):3737-3746. doi: 10.21037/jtd-20-700.
Aortic stenosis (AS) is a progressive and degenerative disease that necessitates valve replacement through either surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR). Various studies have shown that, unlike for TAVR, SAVR is associated with an elevated risk for women as compared to men. The aim of this review is to better understand the risks and their possible causes, associated with the use of both TAVR and SAVR in female patients. Our systematic review included studies published between 2012 and 2020, identified through specific searches of PubMed. Compatibility of publications, determined by the use of pre-defined inclusion/exclusion criteria, resulted in 15 articles being used in our review. Overall, more men than women undergo SAVR, but our findings confirmed that SAVR is associated with worse outcomes in women in the short-term. Reasons for a higher 30-day mortality post-SAVR in women include an increased age, higher in-hospital mortality and, possibly baseline comorbidities and anatomical differences. There was no difference observed in 30-day mortality between men and women undergoing TAVR. Female patients appear to have a better longer-term survival post-TAVR than their male counterparts. Understanding the reasons why women have worse outcomes post-SAVR is essential for ensuring appropriate treatment selection for patients with AS, as well as for achieving the best possible long-term and safety outcomes for these patients.
主动脉瓣狭窄（AS）是一种进行性退行性疾病，需要通过外科主动脉瓣置换术（SAVR）或经导管主动脉瓣置换术（TAVR）进行瓣膜置换。各种研究表明，与TAVR不同，与男性相比，SAVR使女性面临的风险更高。本综述的目的是更好地了解女性患者使用TAVR和SAVR的风险及其可能原因。我们的系统综述纳入了2012年至2020年间发表的研究，这些研究通过对PubMed进行特定检索确定。通过使用预先定义的纳入/排除标准来确定出版物的兼容性，最终有15篇文章被用于我们的综述。总体而言，接受SAVR的男性多于女性，但我们的研究结果证实，SAVR在短期内会使女性的预后更差。女性SAVR术后30天死亡率较高的原因包括年龄增加、院内死亡率较高，以及可能存在的基线合并症和解剖学差异。接受TAVR的男性和女性在30天死亡率方面没有差异。女性患者TAVR术后的长期生存率似乎高于男性。了解女性SAVR术后预后较差的原因对于确保为AS患者选择合适的治疗方法以及为这些患者实现最佳的长期和安全预后至关重要。
