Sex differences in patients undergoing heart transplantation and LVAD therapy

ABSTRACT

Introduction

Left ventricular assist device (LVAD) and heart transplantation (HT) are the two life-sustaining therapies that have revolutionized the management of end-stage heart failure (HF). Yet, significant sex differences exist with respect to their use and effects.

Areas Covered

This review summarizes sex differences in the utilization, outcomes, and complications of LVAD and HT. Particular emphasis is placed on leading clinical trials in the field, historical and recent large registries-based analyses, as well as contemporary technological and policy changes affecting these differences.

Expert Opinion

Women with advanced HF remain under-treated with guideline-directed medical therapy and are less likely to be referred for consideration for LVAD and HT. This remains true despite newer LVAD technology and the new heart transplant allocation system. Community outreach, education, as well as increased representation of women in clinical research may reduce inequities.

KEYWORDS:

• Heart transplantation
• left ventricular assist device
• sex differences
• disparities
• heart failure

Article highlights

• Significant sex differences exist in the application and outcomes of heart transplantation and left ventricular assist devices.

• Women compose approximately 20–25% of all LVAD and HT recipients.

• Post-LVAD complications such as stroke, bleeding, infection, arrhythmia, pump thrombosis, and right ventricular failure are more prevalent in women.

• Following HT, women are more prone to develop allograft failure and antibody-mediated rejection but experience lower rates of cardiac allograft vasculopathy and malignancy.

• Survival rates are lower in women than in men following LVAD implantation, but survival rates are similar following HT.

Declaration of interest

N Uriel has received grants from Abbott. G Sayer has received consulting fees and honoraria from Abbott. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.