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Sex-Specific Outcome Disparities in Patients Receiving Continuous-Flow Left Ventricular Assist Devices: A Systematic Review and Meta-analysis

Blumer, Vanessa*; Mendirichaga, Rodrigo; Hernandez, Gabriel A.; Zablah, Gerardo*; Chaparro, Sandra V.§

doi: 10.1097/MAT.0000000000000695
Review Articles

Continuous-flow left ventricular assist devices (CF-LVADs) decrease mortality and improve quality of life in patients with advanced heart failure (HF). Their widespread utilization has led to concerns regarding increased adverse effects, especially in women. Nevertheless, sex-specific data remain limited. We searched Medline, Embase, Scopus, and the Cochrane Library for publications reporting sex-specific outcomes after CF-LVADs from January 2008 through January 2017. Outcomes were compared under the random-effects model and heterogeneity examined via χ2 test and I 2 statistics. A total of 10 studies including 4,493 CF-LVAD recipients were included in the analysis (23.5% women). The overall rate of stroke was significantly higher in women (odds ratio [OR] 1.94; 95% confidence interval [CI] 1.32–2.84; p = 0.0007). This was true for ischemic strokes (OR 2.03; 95% CI 1.21–3.42; p = 0.008) and hemorrhagic strokes (OR 2.03; 95% CI 1.21–3.42; p = 0.008). Women were also more likely to develop right HF necessitating right ventricular assist device (RVAD) implantation (OR 2.12; 95% CI 1.08–4.15; p = 0.03). Other adverse events including renal failure, bleeding, and device-related infection were comparable for both genders. The overall mortality while on CF-LVAD was similar in both groups (OR 1.05; 95% CI 0.81–1.36; p = 0.71). Our analysis suggests that women are at greater risk of significant complications such as cerebrovascular events and right HF necessitating RVAD after CF-LVAD implantation. Further research is needed to better understand the mechanisms underlying these sex-specific outcome disparities.

From the *Department of Internal Medicine, University of Miami Miller School of Medicine, Miami, Florida

Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts

Division of Advanced Heart Failure and Transplant Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee

§Division of Cardiovascular Medicine, University of Miami Miller School of Medicine, Miami, Florida.

Submitted for consideration April 2017; accepted for publication in revised form August 2017.

Disclosure: Dr. Chaparro was supported by Medtronic and St Jude. She is a paid consultant for that company.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML and PDF versions of this article on the journal’s Web site (

Correspondence: Sandra V. Chaparro, MD, Heart Failure and Transplant Program, Cardiovascular Medicine, University of Miami Miller School of Medicine, Clinical Research Building, Room 1110, 1120 NW 14th Street, Miami, FL 33136. Email:

Copyright © 2018 by the American Society for Artificial Internal Organs