Female-specific survival advantage from transcatheter aortic valve implantation over surgical aortic valve replacement: Meta-analysis of the gender subgroups of randomised controlled trials including 3758 patients

Vasileios F. Panoulas, Darrel P. Francis, Neil Ruparelia, Iqbal S. Malik, Andrew Chukwuemeka, Sayan Sen, Jonathan Anderson, Petros Nihoyannopoulos, Nilesh Sutaria, Edward L. Hannan, Zaza Samadashvili, Paola D'Errigo, Gerhard Schymik, Roxana Mehran, Alaide Chieffo, Azeem Latib, Patrizia Presbitero, Julinda Mehilli, Anna Sonia Petronio, Marie Claude MoriceCorrado Tamburino, Hans G.H. Thyregod, Martin Leon, Antonio Colombo, Ghada W. Mikhail

Research output: Contribution to journalArticlepeer-review

16 Scopus citations

Abstract

Transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS) is the first area of interventional cardiology where women are treated as often as men. In this analysis of the gender specific results of randomised controlled trials (RCTs) comparing TAVI with surgical aortic valve replacement (SAVR) we aimed to determine whether gender affects the survival comparison between TAVI and SAVR. We identified all RCTs comparing TAVI versus SAVR for severe AS and reporting 1 and/or 2 year survival. Summary odds ratios (ORs) were obtained using a random-effects model. Heterogeneity was assessed using the Q statistic and I2. Four RCTs met the criteria, totalling 3758 patients, 1706 women and 2052 men. Amongst females, TAVI recipients had a significantly lower mortality than SAVR recipients, at 1 year (OR 0.68; 95%CI 0.50 to 0.94) and at 2 years (OR 0.74; 95%CI 0.58 to 0.95). Amongst males there was no difference in mortality between TAVI and SAVR, at 1 year (OR 1.09; 95%CI 0.86 to 1.39) or 2 years (OR 1.05; 95%CI 0.85 to 1.3). The difference in treatment effect between genders was significant at both 1 year (pinteraction = 0.02) and 2 years (pinteraction = 0.04). In women TAVI has a 26 to 31% lower mortality odds than SAVR. In men, there is no difference in mortality between TAVI and SAVR.

Original languageEnglish (US)
Pages (from-to)66-72
Number of pages7
JournalInternational Journal of Cardiology
Volume250
DOIs
StatePublished - Jan 1 2018
Externally publishedYes

Keywords

  • Female gender
  • Meta-analysis
  • Surgical aortic valve replacement
  • Transcatheter aortic valve implantation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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