Hospital outcomes of transcatheter versus surgical aortic valve
replacement in female in the United States
Tomo Ando, MD
Emmanuel Akintoye, MD, MPH
Tesfaye Telila, MD
Alexandros Briasoulis, MD, PhD
Hisato Takagi, MD, PhD
Theodore Schreiber, MD
Luis Afonso, MD
Cindy L. Grines, MD
Wayne State University, Harper hospital/
Detroit Medical Center, Division of
Cardiology, Detroit, Michigan
Mayo Clinic, Division of Heart Failure,
Shizuoka Medical Center, Division of
Cardiovascular Surgery, Shizuoka, Japan
Wayne State University, Harper hospital,
North Shore University Hospital, Northwell
Health System, Department of Internal
Medicine, Division of Cardiology,
Manhasset, New York, United States
Tomo Ando, Wayne State University,
Harper hospital/Detroit Medical Center,
Division of Cardiology, Detroit, Michigan.
Objectives: To assess the in-hospital mortality and complications in female between transcatheter
aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR).
Background: Female is one of the risk factors for increased adverse events in cardiac surgery.
Methods and results: Nationwide Inpatient Sample database was queried from 2011 to 2014 for
patients who underwent TAVR or SAVR in female patients. The primary endpoint was in-hospital
all-cause mortality and second endpoints were perioperative complications. We performed a pro-
pensity score analysis to calculate the adjusted odds ratio (OR) for each outcome. Patients who
had concomitant cardiac surgery and those who had TAVR or SAVR mainly for aortic regurgitation
were excluded. Our query from 2011 to 2014 resulted in a total of 3,067 TAVR and 18,594 SAVR
in female patients. TAVR patients were in general elder and had a higher burden of comorbidities.
The primary endpoint was similar between TAVR and SAVR (4.2% vs. 3.9%, OR 1.0, P 5 0.89).
Compared to SAVR, female TAVR patients had less hemorrhage requiring transfusion (12% vs.
21%, OR 0.41, P < 0.001), perioperative cardiac arrest and nonfatal myocardial infarction (9.8% vs.
17%, OR 0.38, P < 0.001), respiratory complication (1.6% vs. 4.4%, OR 0.28, P < 0.001), post-op
sepsis (1.7% vs. 2.9%, OR 0.65, P 5 0.03), acute myocardial infarction (3.0% vs. 4.9%, OR 0.60,
P < 0.001), and acute kidney injury (15% vs. 18%, OR 0.62, P < 0.001). Conversely, female TAVR
patients had significantly increased risk of new pacemaker implantation (11% vs. 5.9%, OR 1.7,
P < 0.001) and use of extracorporeal membrane oxygenation (0.66% vs. 0.24%, OR 2.8,
P < 0.001). TAVR patients had less nonroutine discharge. The median hospital cost was signifi-
cantly higher in TAVR than SAVR (median $51,274 vs. $43,677, P < 0.001) but the length of stay
was shorter (mean 7.8 days vs. 10.5 days).
Conclusions: TAVR may be a better option for those patients with underlying comorbidities that
predispose them at higher risk for complications that was less observed in TAVR group. However,
higher cost and increased risk of need for extracorporeal membrane oxygenation, although rare,
should be taken into consideration upon deciding the optimal mode for aortic valve replacement.
aortic stenosis, female, surgical aortic valve replacement, transcatheter aortic valve replacement,
Catheter Cardiovasc Interv. 2018;91:813–819. wileyonlinelibrary.com/journal/ccd
2017 Wiley Periodicals, Inc.
Received: 13 June 2017
Revised: 2 September 2017
Accepted: 9 September 2017