Department of Cardiothoracic Surgery; UPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
UPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Department of Interventional Cardiology, University of Pittsburgh, Pittsburgh, Pennsylvania.
Am J Cardiol. 2024 Sep 15;227:75-82. doi: 10.1016/j.amjcard.2024.07.029. Epub 2024 Jul 25.
Patients with small aortic annuli (SAAs) are predominantly women. We sought to compare gender-based and propensity-matched outcomes of index transcatheter aortic valve replacement (TAVR) in patients with SAAs. In this retrospective institutional analysis (2012 to 2023), primary stratification was by gender. SAA was defined as an aortic valve annulus diameter <23 mm and the 30-day and 1-year outcomes were compared between the groups. A total of 3,911 patients underwent TAVR. Of those, 661 patients had an SAA, of whom 23.8% were men and 76.2% were women. Propensity matching (1:1) identified 152 pairs. The mean age was 81 years. History of surgical or percutaneous coronary intervention was more prevalent in men (72.4% vs 48%, p <0.001). Men had a higher incidence of postoperative pacemaker implantation (8.6% vs 3.3%, p = 0.05), whereas only women had iliofemoral dissections (4.6% vs 0%, p = 0.007). The rates of moderate (23.0% vs 25.7%) and severe (2.6% vs 0.7%) prosthesis-patient mismatch was not statistically significantly different between the groups (p = 0.364). The 30-day mortality was 0%, whereas the 1-year mortality was 4.3%, with no difference between the groups. An increase in preoperative creatinine was associated with higher risk of death (hazard ratio 1.206, 95% confidence interval 1.025 to 1.418, p = 0.02), whereas gender was not. Kaplan-Meier survival estimates (Log rank, p = 0.768) and cumulative incidence of stroke readmission (p = 0.842) were similar in both groups. In conclusion, the outcomes of TAVR in SAAs do not differ by gender, with safety and efficacy evident in men and women.
患有小主动脉瓣环（SAA）的患者主要为女性。我们旨在比较 SAA 患者中基于性别的指数经导管主动脉瓣置换术（TAVR）的性别匹配和倾向匹配结果。在这项回顾性机构分析中（2012 年至 2023 年），主要分层是性别。SAA 定义为主动脉瓣环直径<23mm，比较两组患者的 30 天和 1 年结果。共有 3911 名患者接受了 TAVR。其中，661 名患者有 SAA，其中 23.8%为男性，76.2%为女性。倾向匹配（1:1）确定了 152 对。平均年龄为 81 岁。手术或经皮冠状动脉介入治疗史在男性中更为常见（72.4%对 48%，p<0.001）。男性术后起搏器植入发生率较高（8.6%对 3.3%，p=0.05），而只有女性有髂股动脉夹层（4.6%对 0%，p=0.007）。中度（23.0%对 25.7%）和重度（2.6%对 0.7%）人工瓣膜-患者不匹配率在两组间无统计学差异（p=0.364）。30 天死亡率为 0%，1 年死亡率为 4.3%，两组间无差异。术前肌酐升高与死亡风险增加相关（风险比 1.206，95%置信区间 1.025 至 1.418，p=0.02），而性别无关。两组的 Kaplan-Meier 生存估计（对数秩，p=0.768）和中风再入院的累积发生率（p=0.842）相似。总之，SAA 患者的 TAVR 结果不因性别而异，男性和女性均安全有效。
