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Gender difference impact on transcatheter aortic valve replacement outcomes: a systematic review and meta-analyses
Session:
SESSÃO DE POSTERS 16 - DIAGNÓSTICO E PROGNÓSTICO NA ESTENOSE AÓRTICA
Speaker:
Mariana J. Almeida
Congress:
CPC 2025
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
15. Valvular Heart Disease
Subtheme:
15.4 Valvular Heart Disease – Treatment
Session Type:
Cartazes
FP Number:
---
Authors:
Estudante; Dr. Gonçalo Ferraz Costa; Dra. Helena Donato; Dra. Joana Delgado Silva; Dr. Lino Gonçalves
Abstract
<div style="text-align:start"> <p style="text-align:justify"><span style="color:#000000"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:black">Abstract</span></span></span></strong></span></span></span></p> <p style="text-align:justify"><span style="color:#000000"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:black">Introduction:</span></span></span></strong><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:black"> Previous studies have associated female sex with worse outcomes after surgical aortic valve replacement (SAVR). However, data on sex-specific differences following transcatheter aortic valve implantation (TAVI) remain conflicting. Since TAVI is more frequently performed in women, understanding the relationship between gender disparities and TAVI outcomes is essential.</span></span></span></span></span></span></p> <p style="text-align:justify"><span style="color:#000000"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:black">Objectives: </span></span></span></strong><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:black">This study aims to evaluate and summarize all available randomized clinical trial-based evidence regarding the outcomes of transcatheter aortic valve implantation (TAVI) in women compared to men.</span></span></span></span></span></span></p> <p style="text-align:justify"><span style="color:#000000"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:black">Methods: </span></span></span></strong><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:black">We utilized PubMed, Web of Science and Embase as databases, and our last search was made on 1st of July 2024. We only searched for Randomized Clinical Trials written in English. Following the PICO method, we established our investigation question. We included only </span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:black">studies reporting outcomes with TAVI in women versus men. Mantel-Haenszel random-effect model Odd Ratios were calculated. The main outcome was all-cause mortality.</span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:black"> Our measure of effect was Odds Ratio (OR), and we selected the random effects option. </span></span></span></span></span></span></p> <p style="text-align:justify"><span style="color:#000000"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:black">Results:</span></span></span></strong> <span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:black">This systematic review included 14 studies, encompassing a total of 15225 participants. Regarding the primary outcome of all-cause mortality, variations appeared to depend on the type of valve used; however, no significant subgroup differences were observed. Female gender was identified as a protective factor for all-cause mortality among intermediate-risk patients (OR: 0.64; 95% CI: 0.49 to 0.84; Z=3.27; P= 0.001; I²=0%), but had an increased risk of major bleeding (OR: 1.35; 95% CI: 1.21 to 1.52; Z=5.22; P<0.00001; I²=15%) .</span></span></span></span></span></span></p> <p style="text-align:justify"><span style="color:#000000"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:black">Regarding the outcomes permanent pacemaker implantation after TAVI (OR: 1.05; 95% CI: 0.62 to 1.77; Z=0.17; P=0.86; I²=87%), stroke/transient ischemic attack (OR: 0.96; 95% CI: 0.85 to 1.08; Z=0.69; P=0.49; I²=0%), and cardiovascular mortality (OR: 0.98; 95% CI: 0.74 to 1.29; Z=0.15; P=0.88; I²=58%) there were no statistically significant differences based on sex.</span></span></span></span></span></span></p> <p style="text-align:justify"><span style="color:#000000"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:black">Conclusion: </span></span></span></strong><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:black">This analysis suggests that female gender serves as a protective factor against all-cause mortality in intermediate-risk patients. However, women demonstrated an elevated risk of major bleeding post-procedure. Future randomized clinical trials should aim for greater objectivity and include larger sample sizes.</span></span></span></span></span></span></p> <p style="text-align:justify"><span style="color:#000000"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:black">Keywords:</span></span></span></strong><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:black"> “Aortic Valve Stenosis,” “Mortality,” “Sex Characteristics,” “Transcatheter Aortic Valve Replacement,” “TAVR”</span></span></span></span></span></span></p> </div> <div> </div> <p> </p>
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