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DOI: 10.1055/s-0036-1571568
Prior Hip Surgery Leads to Gender Related Increase in Complication Rates after Transcatheter Aortic Valve Implantation
Objective: Aim of this study was to evaluate the potential impact outcomes of patients undergoing transfemoral transcatheter aortic valve implantation (TAVI) after prosthetic hip surgery.
Methods: A cohort of 443 patients that underwent transfemoral TAVI between July 2012 to May 2015 were analyzed, of whom 50 had prior prosthetic hip surgery (PHS). The mean age was 80.75 ± 5.1 years and 240 (54.2%) were female. Peripheral vascular disease was present in 12% (PHS) and 11.2%. Aortic valve calcification according to the Agatston score was comparable in both groups (2696.6 (PHS) vs 2750.2 respectively). Primary clinical endpoints were vascular and procedural complications as well as 30 day and midterm mortality.
Results: 30 day mortality was 12% (PHS) versus 3.6%, p = 0.04. The overall mortality at 30day follow up was 22% (PHS) versus 10.9%, p = 0.05. Major vascular complications occurred in 14% (PHS) versus 6.4%, p = 0.04. In the PHS group, female gender was significantly associated with complications, which occurred in12% of female versus 2% of male patients (p = 0.02). In the control group occurrence of complications was not related to patient gender, 8.4% (female) versus 8.9% (male), p = n.s.
Discussion: This study shows that there is a significant difference in morbidity and mortality between patients that underwent hip surgery prior to TAVI and those without. Complications were seen more frequently in female patients. Therefore, one should consider alternative access options such as transapical TAVI, for female patients that had prior prosthetic hip surgery.