Abstract
Introduction The prevalence of heart failure (HF) in men and women is similar. However, guideline directed medical and advanced heart therapies, including left ventricular assist devices (LVAD) and heart transplant (Htx) are underused in women. Hypothesis Sex-related differences are observed in advanced heart failure and may affect outcomes after LVAD and Htx. Methods TransAtlantic Registry on VAD and Transplant (TRAVIATA) is a retrospective, multinational (Italy, Sweden, Croatia, Netherlands, Belgium, USA) registry that includes patients with LVAD (HeartWare, Heartmate II) with bridge to transplant (BTT) strategy. Patients with HeartMate 3, BIVAD or total artificial heart devices were excluded. Primary outcomes include frequency of Htx, waitlist time and survival. Results A total of 524 patients (15.6% women) received LVAD with BTT treatment strategy from 2008 to 2017. Baseline characteristics between men and women were matched, including HVAD use (38.7% vs 47.6%, p = 0.142) with notable differences in LVEDD (7.0 (1.5) vs 6.3 (1.5) cm (IQR), p = 0.001), TAPSE (1.5 (0.5) vs 1.7 (0.5) cm (IQR), p = 0.02) and INTERMACS class 1-2 (43.3% vs 59.8%, p = 0.008). Frequency of Htx (57.9% vs 58.3%, p = 0.087) with a median waitlist time (369 (568) vs 311 (367) days (IQR), p = 0.07) was similar between men and women. Survival differences by Kaplan Meir analysis at 5 years (p = 0.925) were not observed. Post-LVAD complications were significant for increased stroke in women compared to men (24.4% vs 13.4%, p = 0.018). Conclusion In this multinational registry, there were no observed sex differences in frequency of Htx, waitlist time or survival. However, greater severity of disease at time of therapy in women may suggest delays in diagnosis or decision to enlist these patients for therapy, highlighting a potential discordance in use of advanced HF therapies by sex.
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