Search

Aim: Significant aortic regurgitation (AR) has been reported in 20% of patients undergoing transfemoral aortic valve implantation (TAVI) and has been associated with increased mortality. Depending on the population included and the type of implanted prosthesis, several anatomical and procedural factors have been linked with increased risk of post-TAVI AR. While the impact of patients' gender on this complication, is still contradictory. We sought to assess the impact of patients' gender on the risk of significant AR after TAVI., Methods: We included 323 consecutive patients (136 men) who underwent transfemoral implantation of either self-expandable or balloon-expandable prostheses for treatment of symptomatic aortic stenosis., Results: After TAVI 52 patients (16.1%) had AR grade ≥ 2/4 as evaluated by angiography. They were more frequently male (59.6% vs. 40.4%, P = 0.005), received self-expandable (94.2% vs. 63.5%, P < 0.001) and bigger size prostheses (28 ± 1.9 vs. 27.3 ± 2.1 mm, P = 0.028) and had reduced left ventricular ejection fraction (45.3% ± 14.2% vs. 51.2% ± 13%, P = 0.003) compared to patients with AR grade < 2/4 (N. = 271). In multivariate analysis, men (OR 2.13 [95% CI, 1.08-4.18]) and prosthesis type (OR 13.17 [95% CI, 3.24-57.97]) were identified as independent predictors of AR grade ≥ 2/4., Conclusion: Alongside with the implantation of self-expandable aortic prosthesis, male gender independently increases the risk of significant AR in patients undergoing TAVI. The question if this finding is related to gender biology itself or to gender-related aggregation of subtle anatomic characteristics needs further investigations.

Percutaneous coronary interventions (PCI) have gained widespread acceptation among cardiologists and among the general population for a variety of clinical indications, comprising from stable angina to ST-elevation acute myocardial infarction, due to the undisputed clinical benefit they provide and to their large availability and accessibility. Nonetheless PCI in the left main coronary artery (LMCA) is still controversial. Traditionally the revascularization of the LMCA has been one of those exceptions in which surgery was preferred to PCI, although PCI still found a slot in non-surgically-suitable cases or as bailout intervention. Some evidence has been recently generated, that challenges this traditional approach, and also about the clinical advantages of new-generation intracoronary devices, among them the drug-eluting stents with biodegradable polymers in abluminal coating. This scenario opens new horizons for the treatment of LMCA disease, in which a more prominent role of PCI can be anticipated.