Five-Year Outcomes of Transcatheter Versus Surgical Aortic Valve Replacement in Women: A Systematic Review and Meta-Analysis

OBJECTIVES: Women patients with aortic stenosis (AS) exhibit distinct anatomic and physiologic features that may influence outcomes after valve replacement. While transcatheter aortic valve replacement (TAVR) has shown early advantages over surgical aortic valve replacement (SAVR) in women, long-term sex-specific outcomes remain unclear. To evaluate outcomes at 5 years comparing TAVR versus SAVR a systematic review and meta-analysis was performed. METHODS: A systematic literature review was conducted, identifying all randomized controlled trials (RCTs) comparing TAVR with SAVR which included women with completed 5-year follow-up. The primary outcome was the composite of all-cause mortality or disabling stroke. Meta-analysis was performed using both random-effects and fixed-effect models. The study protocol was registered in PROSPERO (CRD420251004394). RESULTS: Six RCTs were included with a total of 3094 women (1587 TAVR and 1507 SAVR). Overall, no significant difference was observed in the primary outcome between TAVR and SAVR (incidence rate ratios [IRRs] 1.00, 95% confidence interval [CI]: 0.88-1.13, P = .98). Meta-regression did not find any association between key clinical covariates and the primary outcome. Trial sequential analysis demonstrated that the extracted sample size met the required information size, but a definitive treatment effect was not confirmed. CONCLUSIONS: While TAVR shows an advantage over SAVR at 1-year follow-up in women, all-cause mortality or disabling stroke is similar in TAVR and SAVR at 5 years. Future studies must include sex-disaggregated reporting of both primary and secondary outcomes in order to comprehensively weigh risks and benefits of each intervention and inform personalized treatment strategies. CLINICAL REGISTRATION NUMBER: The study protocol was registered in PROSPERO (CRD420251004394).