Significant aortic regurgitation after transfemoral aortic valve implantation: patients' gender as independent risk factor.

Jochheim, D; Abdel-Wahab, M; Mehilli, J; Ellert, J; Wübken-Kleinfeld, N; El-Mawardy, M; Pache, J; Massberg, S; Kastrati, A; Richardt, G

journal article

Document type:: Journal Article
Author(s):: Jochheim, D; Abdel-Wahab, M; Mehilli, J; Ellert, J; Wübken-Kleinfeld, N; El-Mawardy, M; Pache, J; Massberg, S; Kastrati, A; Richardt, G
Title:: Significant aortic regurgitation after transfemoral aortic valve implantation: patients' gender as independent risk factor.
Abstract:: Significant aortic regurgitation (AR) has been reported in 20% of patients undergoing transfemoral aortic valve implantation (TAVI) and has been associated with increased mortality. Depending on the population included and the type of implanted prosthesis, several anatomical and procedural factors have been linked with increased risk of post-TAVI AR. While the impact of patients' gender on this complication, is still contradictory. We sought to assess the impact of patients' gender on the risk of significant AR after TAVI.We included 323 consecutive patients (136 men) who underwent transfemoral implantation of either self-expandable or balloon-expandable prostheses for treatment of symptomatic aortic stenosis.After TAVI 52 patients (16.1%) had AR grade >= 2/4 as evaluated by angiography. They were more frequently male (59.6% vs. 40.4%, P = 0.005), received self-expandable (94.2% vs. 63.5%, P < 0.001) and bigger size prostheses (28 ± 1.9 vs. 27.3 ± 2.1 mm, P = 0.028) and had reduced left ventricular ejection fraction (45.3% ± 14.2% vs. 51.2% ± 13%, P = 0.003) compared to patients with AR grade < 2/4 (N. = 271). In multivariate analysis, men (OR 2.13 [95% CI, 1.08-4.18]) and prosthesis type (OR 13.17 [95% CI, 3.24-57.97]) were identified as independent predictors of AR grade >= 2/4.Alongside with the implantation of self-expandable aortic prosthesis, male gender independently increases the risk of significant AR in patients undergoing TAVI. The question if this finding is related to gender biology itself or to gender-related aggregation of subtle anatomic characteristics needs further investigations.
Journal title abbreviation:: Minerva Cardioangiol
Year:: 2015
Journal volume:: 63
Journal issue:: 5
Pages contribution:: 371-9
Language:: eng
Pubmed ID:: http://view.ncbi.nlm.nih.gov/pubmed/25812583
Print-ISSN:: 0026-4725
TUM Institution:: Klinik für Herz- und Kreislauferkrankungen im Erwachsenenalter (Prof. Schunkert)
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mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Lehr- und Forschungskooperationen mit den Kliniken und Instituten am Deutschen Herzzentrum Klinik für Herz- und Kreislauferkrankungen im Erwachsenenalter (DHM) (Prof. Schunkert)2015