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Gender differences in the assessment, decision-making and outcomes for ventricular assist devices and heart transplantation: An analysis from a UK transplant center

Lookup NU author(s): Dr Guy MacGowanORCiD, Dr Adam McDiarmid, Dr Katrijn Jansen, Dr Louise CoatsORCiD, Dr David Crossland, Dr Vijay KunadianORCiD, Dr Asif Shah, Dr Stephan Schueler, Dr Gareth Parry

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Abstract

© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. Purpose: There are marked gender differences in all etiologies of advanced heart failure. We sought to determine whether there is evidence of gender-specific decision making for transplant assessments, and how gender effects outcomes. Methods: Retrospective analysis of adult heart transplant assessments at a single UK center between April 2015 and March 2020. Results: Females were 32% of referrals (N = 137 females, 285 males), with marked differences between diagnoses – 11% ischemic and 43% of adult congenital. Females were younger, shorter, weighed less, and had lower pulmonary pressures. Females were much less likely to receive a ventricular assist device (13%). Blood type “O” females were relatively more likely compared to males to receive a transplant (45%). Comparing males and females who received a ventricular assist device, both had similar levels of high pulmonary pressures, indicating consistent decision-making based on hemodynamics to implant a device. Overall survival was better for females (in noncongenital patients), and this was due to female patients who were not accepted for transplant or a ventricular assist device being more often “too well for transplant,” rather than in males when they were more often “unsuitable.”. Conclusions: Marked gender differences exist at all stages of the heart transplant assessment pathway. Appropriate decision-making based on clinical grounds is shown with less transplants in male blood type “O”s and hemodynamic criteria for ventricular assist device implantation in both genders. Further studies are needed to determine if there is a wider community bias in advanced heart failure treatments for females.


Publication metadata

Author(s): MacGowan GA, McDiarmid A, Jansen K, Coats L, Crossland D, Woods A, Kunadian V, Shah A, Schueler S, Parry G

Publication type: Article

Publication status: Published

Journal: Clinical Transplantation

Year: 2022

Volume: 36

Issue: 6

Print publication date: 01/06/2022

Online publication date: 06/04/2022

Acceptance date: 31/03/2022

ISSN (print): 0902-0063

ISSN (electronic): 1399-0012

Publisher: Wiley-Blackwell Publishing, Inc.

URL: https://doi.org/10.1111/ctr.14666

DOI: 10.1111/ctr.14666

PubMed id: 35385147


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