1Universitätsklinikum Giessen und Marburg GmbH Klinik für Innere Medizin - Schwerpunkt Kardiologie Marburg, Deutschland; 2RHÖN-KLINIKUM AG Campus Bad Neustadt Klinik für Kardiologie I - Interventionelle Kardiologie und kardiale Bildgebung Bad Neustadt a. d. Saale, Deutschland; 3Universitätsklinikum Giessen und Marburg GmbH Klinik für Kardiologie, Angiologie und internistische Intensivmedizin Marburg, Deutschland; 4Klinikum Rheine Medizinische Klinik II - Kardiologie Rheine, Deutschland; 5Ostalb-Klinikum Aalen Innere Medizin II, Kardiologie und Angiologie Aalen, Deutschland; 6Universitäts-Herzzentrum Freiburg / Bad Krozingen Klinik für Kardiologie und Angiologie Bad Krozingen, Deutschland
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, 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 were 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), 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 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 after 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.
CONCLUSION: 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.