TAVR (TAVI) in Women. Nuances of transcatheter aortic valve replacement in female patients. 5
TAVI (TAVR) in women with aortic stenosis has several nuances. They relate to size of aortic annulus and blood flow through the heart. Leading cardiologist explains. Aortic valve replacement in women. Dr. Anton Titov, MD. Are there nuances in transcatheter aortic valve replacement for men and women? Dr. Anton Titov, MD. TAVI or TAVR procedures are different in women compared with male patients? Dr. Jeffrey Popma, MD. The women versus men quandary has been around for a long time. Our cardiac surgeons have known that in women, particularly smaller women, there is a problem. Sometimes the aortic annulus and the body build is a little bit smaller than in men. Dr. Jeffrey Popma, MD. Sometimes smaller valves need to be used. We looked at this in our randomized trial of high-risk patients women versus men. We found that women did pretty well with transcatheter aortic valve replacement compared to surgical aortic valve replacement. We think that was a frail population of patients. Dr. Jeffrey Popma, MD. Maybe it doesn’t really hold true to younger patients. That’s why we are studying that now. But at least in elderly women who are infirm, the TAVR seems to be a lesser invasive therapy. Dr. Anton Titov, MD. TAVI is associated with better gradients compared to open surgery to replace aortic valve. Dr. Kim Skelding published this in the American Journal of Cardiology. That is actually very very important. But one of the things that we do know now is that. A lot of the outcomes to compare Transcatheter aortic valve replacement vs. surgical aortic valve replacement relate to your ability to recover from stress. We are seeing a 90-pound woman or a 90-pound man. Dr. Jeffrey Popma, MD. But we commonly see 90-pound women, who are 5 feet tall and very frail. The operations are just harder to do in those patients. Dr. Anton Titov, MD. Because the hemodynamics of the size of aortic valve that can be placed is more challenging in surgery. The recovery time can be more problematic in women compared to men. Dr. Jeffrey Popma, MD. So in those cases we do think that the TAVR is not just equivalent but preferred method to replace aortic valve. it is true particularly in the intermediate to high-risk patient pool. TAVI is better than the surgical aortic valve replacement. Because we can get a larger aortic valve into a patient’s heart. It is relative to the size of the aortic annulus. We can achieve lower gradients across implanted aortic valve. We can leave the patients with less prosthesis-patient mismatch. Dr. Jeffrey Popma, MD. All those benefits are in addition to the rapid recovery time with TAVR. Dr. Anton Titov, MD. Patients will be better by not having an open-heart aortic valve surgery.
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