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Sex-Specific Disparities in Outcomes of Transcatheter Edge-to-Edge Repair for Mitral Regurgitation: A Multicenter “Real-World” Analysis
Background: mitral regurgitation (mr) is the most common valvular heart disease (vhd) in the elderly and tends to be more prevalent in women. while relevant sex differences in outcomes are evident in surgically treated collectives, there are very limited and conflicting sex-specific data for the...
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| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Philipps-Universität Marburg
2023
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| Subjects: | |
| Online Access: | PDF Full Text |
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| Summary: | Background: mitral regurgitation (mr) is the most common valvular heart disease (vhd) in
the elderly and tends to be more prevalent in women. while relevant sex differences in outcomes are
evident in surgically treated collectives, there are very limited and conflicting sex-specific data for the
growing cohort of patients undergoing transcatheter edge-to-edge repair (teer). Objective: to investigate
whether sex impacts procedural safety and efficacy, and in-hospital- and long-term outcomes,
after teer for mr. Methods: in a multicenter observational cohort study, patients who underwent
teer were stratified by sex and relevant outcome measures, and analyzed using multivariable cox
regression and propensity score matching (psm). Results: a total of 821 patients were analyzed, of
whom 37.4% (307/821) were female. compared to male patients, females were significantly older
(77 � 8.5 vs. 80.4 � 6.7 years, p = 0.03), and had less coronary artery disease (cad, 67.7% vs. 53.1%,
p < 0.0001) and a higher proportion of preserved left ventricular function (lvef > 50%, 32.5% vs. 50.5%,
p > 0.0001). safety and efficacy of the teer procedure and in-hospital mortality did not differ between
the sexes. after psm, women showed significantly better survival 3 years after teer compared to men
(60.7% vs. 54.2%, p = 0.04) and a lower risk of all-cause death according to multiple cox regression
(hr 0.8, 95% ci 0.6–0.9, p = 0.02). after sex-specific stratification for concomitant atrial fibrillation
(af), the most common comorbidity in the present collective, women with af experience significantly
worse adjusted survival compared to women without af (53.9% vs. 75.1%, p = 0.042) three years
after teer and lose the survival advantage over men. Conclusions: female patients are older and
less comorbid than males undergoing TEER. The TEER procedure is equally safe and effective in
both sexes. While in-hospital mortality did not differ, female patients experienced a significantly
better adjusted long-term survival compared to male patients. Concomitant AF offsets the prognostic
advantage of females over males and, in contrast to males, significantly impairs long-term survival
in women undergoing TEER. Further research is warranted to elucidate underlying causes for the
observed sex disparities and to develop sex-tailored treatment recommendations. |
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| Item Description: | Gefördert durch den Open-Access-Publikationsfonds der UB Marburg. |
| DOI: | 10.3390/jcm12237231 |