Sex differences in the utilization and outcomes of surgical aortic valve replacement for severe aortic stenosis

Zakeih Chaker, Vinay Badhwar, Fahad Alqahtani, Sami Aljohani, Chad J. Zack, David Holmes, Charanjit Rihal, Mohamad Alkhouli

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Background-Studies assessing the differential impact of sex on outcomes of aortic valve replacement (AVR) yielded conflicting results. We sought to investigate sex-related differences in AVR utilization, patient risk profile, and in-hospital outcomes using the Nationwide Inpatient Sample. Methods and Results-In total, 166 809 patients (63% male and 37% female) who underwent AVR between 2003 and 2014 were identified, and 48.5% had a concomitant cardiac surgery procedure. Compared with men, women were older and had more nonatherosclerotic comorbid conditions including hypertension, diabetes mellitus, obstructive pulmonary disease, atrial fibrillation/flutter, and anemia but fewer incidences of coronary and peripheral arterial disease and prior sternotomies. Inhospital mortality was significantly higher in women (5.6% versus 4%, P < 0.001). Propensity matching was performed to assess the impact of sex on the outcomes of isolated AVR and yielded 28 237 matched pairs of male and female participants. In the propensity-matched groups, in-hospital mortality was higher in women (3.3% versus 2.9%, P < 0.001). Along with vascular complications and blood transfusion (6% versus 5.6%, P=0.027 and 40.4% versus 33.9%, P < 0.001, respectively). Rates of stroke, permanent pacemaker implantation, and acute kidney injury requiring dialysis were similar (2.4% versus 2.4%, P=0.99; 6% versus 6.3%, P=0.15; and 1.4% versus 1.3%, P=0.14, respectively). Length of stay median and interquartile range were both similar between groups (7±6 days). Rates of nonhome discharge were higher among women (27.9% versus 19.6%, P < 0.001). Conclusions-Women have worse in-hospital mortality following AVR compared with men. Coupled with the accumulating evidence suggesting higher magnitude of benefit of transcatheter AVR over AVR in women, women should perhaps be offered transcatheter AVR over AVR at a lower threshold than men.

Original languageEnglish (US)
Article numbere006370
JournalJournal of the American Heart Association
Volume6
Issue number9
DOIs
StatePublished - Sep 1 2017

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Aortic Valve Stenosis
Aortic Valve
Surgical Instruments
Sex Characteristics
Hospital Mortality
Obstructive Lung Diseases
Atrial Flutter
Sternotomy
Peripheral Arterial Disease
Acute Kidney Injury
Blood Transfusion
Atrial Fibrillation
Thoracic Surgery
Blood Vessels
Anemia
Inpatients
Dialysis
Length of Stay
Diabetes Mellitus
Research Design

Keywords

  • Aortic valve replacement
  • Aortic valve stenosis
  • Disparities
  • Outcome

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Sex differences in the utilization and outcomes of surgical aortic valve replacement for severe aortic stenosis. / Chaker, Zakeih; Badhwar, Vinay; Alqahtani, Fahad; Aljohani, Sami; Zack, Chad J.; Holmes, David; Rihal, Charanjit; Alkhouli, Mohamad.

In: Journal of the American Heart Association, Vol. 6, No. 9, e006370, 01.09.2017.

Research output: Contribution to journalArticle

Chaker, Zakeih ; Badhwar, Vinay ; Alqahtani, Fahad ; Aljohani, Sami ; Zack, Chad J. ; Holmes, David ; Rihal, Charanjit ; Alkhouli, Mohamad. / Sex differences in the utilization and outcomes of surgical aortic valve replacement for severe aortic stenosis. In: Journal of the American Heart Association. 2017 ; Vol. 6, No. 9.
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abstract = "Background-Studies assessing the differential impact of sex on outcomes of aortic valve replacement (AVR) yielded conflicting results. We sought to investigate sex-related differences in AVR utilization, patient risk profile, and in-hospital outcomes using the Nationwide Inpatient Sample. Methods and Results-In total, 166 809 patients (63{\%} male and 37{\%} female) who underwent AVR between 2003 and 2014 were identified, and 48.5{\%} had a concomitant cardiac surgery procedure. Compared with men, women were older and had more nonatherosclerotic comorbid conditions including hypertension, diabetes mellitus, obstructive pulmonary disease, atrial fibrillation/flutter, and anemia but fewer incidences of coronary and peripheral arterial disease and prior sternotomies. Inhospital mortality was significantly higher in women (5.6{\%} versus 4{\%}, P < 0.001). Propensity matching was performed to assess the impact of sex on the outcomes of isolated AVR and yielded 28 237 matched pairs of male and female participants. In the propensity-matched groups, in-hospital mortality was higher in women (3.3{\%} versus 2.9{\%}, P < 0.001). Along with vascular complications and blood transfusion (6{\%} versus 5.6{\%}, P=0.027 and 40.4{\%} versus 33.9{\%}, P < 0.001, respectively). Rates of stroke, permanent pacemaker implantation, and acute kidney injury requiring dialysis were similar (2.4{\%} versus 2.4{\%}, P=0.99; 6{\%} versus 6.3{\%}, P=0.15; and 1.4{\%} versus 1.3{\%}, P=0.14, respectively). Length of stay median and interquartile range were both similar between groups (7±6 days). Rates of nonhome discharge were higher among women (27.9{\%} versus 19.6{\%}, P < 0.001). Conclusions-Women have worse in-hospital mortality following AVR compared with men. Coupled with the accumulating evidence suggesting higher magnitude of benefit of transcatheter AVR over AVR in women, women should perhaps be offered transcatheter AVR over AVR at a lower threshold than men.",
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AU - Chaker, Zakeih

AU - Badhwar, Vinay

AU - Alqahtani, Fahad

AU - Aljohani, Sami

AU - Zack, Chad J.

AU - Holmes, David

AU - Rihal, Charanjit

AU - Alkhouli, Mohamad

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N2 - Background-Studies assessing the differential impact of sex on outcomes of aortic valve replacement (AVR) yielded conflicting results. We sought to investigate sex-related differences in AVR utilization, patient risk profile, and in-hospital outcomes using the Nationwide Inpatient Sample. Methods and Results-In total, 166 809 patients (63% male and 37% female) who underwent AVR between 2003 and 2014 were identified, and 48.5% had a concomitant cardiac surgery procedure. Compared with men, women were older and had more nonatherosclerotic comorbid conditions including hypertension, diabetes mellitus, obstructive pulmonary disease, atrial fibrillation/flutter, and anemia but fewer incidences of coronary and peripheral arterial disease and prior sternotomies. Inhospital mortality was significantly higher in women (5.6% versus 4%, P < 0.001). Propensity matching was performed to assess the impact of sex on the outcomes of isolated AVR and yielded 28 237 matched pairs of male and female participants. In the propensity-matched groups, in-hospital mortality was higher in women (3.3% versus 2.9%, P < 0.001). Along with vascular complications and blood transfusion (6% versus 5.6%, P=0.027 and 40.4% versus 33.9%, P < 0.001, respectively). Rates of stroke, permanent pacemaker implantation, and acute kidney injury requiring dialysis were similar (2.4% versus 2.4%, P=0.99; 6% versus 6.3%, P=0.15; and 1.4% versus 1.3%, P=0.14, respectively). Length of stay median and interquartile range were both similar between groups (7±6 days). Rates of nonhome discharge were higher among women (27.9% versus 19.6%, P < 0.001). Conclusions-Women have worse in-hospital mortality following AVR compared with men. Coupled with the accumulating evidence suggesting higher magnitude of benefit of transcatheter AVR over AVR in women, women should perhaps be offered transcatheter AVR over AVR at a lower threshold than men.

AB - Background-Studies assessing the differential impact of sex on outcomes of aortic valve replacement (AVR) yielded conflicting results. We sought to investigate sex-related differences in AVR utilization, patient risk profile, and in-hospital outcomes using the Nationwide Inpatient Sample. Methods and Results-In total, 166 809 patients (63% male and 37% female) who underwent AVR between 2003 and 2014 were identified, and 48.5% had a concomitant cardiac surgery procedure. Compared with men, women were older and had more nonatherosclerotic comorbid conditions including hypertension, diabetes mellitus, obstructive pulmonary disease, atrial fibrillation/flutter, and anemia but fewer incidences of coronary and peripheral arterial disease and prior sternotomies. Inhospital mortality was significantly higher in women (5.6% versus 4%, P < 0.001). Propensity matching was performed to assess the impact of sex on the outcomes of isolated AVR and yielded 28 237 matched pairs of male and female participants. In the propensity-matched groups, in-hospital mortality was higher in women (3.3% versus 2.9%, P < 0.001). Along with vascular complications and blood transfusion (6% versus 5.6%, P=0.027 and 40.4% versus 33.9%, P < 0.001, respectively). Rates of stroke, permanent pacemaker implantation, and acute kidney injury requiring dialysis were similar (2.4% versus 2.4%, P=0.99; 6% versus 6.3%, P=0.15; and 1.4% versus 1.3%, P=0.14, respectively). Length of stay median and interquartile range were both similar between groups (7±6 days). Rates of nonhome discharge were higher among women (27.9% versus 19.6%, P < 0.001). Conclusions-Women have worse in-hospital mortality following AVR compared with men. Coupled with the accumulating evidence suggesting higher magnitude of benefit of transcatheter AVR over AVR in women, women should perhaps be offered transcatheter AVR over AVR at a lower threshold than men.

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