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June 13, 2026Journal of the American College of Cardiology

Revisiting Sex Equality With Transcatheter Aortic Valve Replacement Outcomes

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Key result

Female sex linked to ~21% lower mortality after TAVR despite more bleeding and vascular events.

  • adjusted HR 0.79
  • 95% CI 0.73 to 0.86
  • P=0.001
  • n=11,310

Why the study?

There has been conflicting clinical evidence regarding the influence of female sex on outcomes after transcatheter aortic valve replacement.

Does female sex influence mortality and safety outcomes in patients undergoing transcatheter aortic valve replacement?

Population

11,310 patients after transcatheter aortic valve replacement across 5 studies

Comparison

Female vs male sex

Design

Collaborative meta-analysis of individual patient-level data

Follow-up

Median 387 days

Authors

SOStephen O’ConnorMMMarie‐Claude MoriceMGMartine Gilard

Discussion

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Overview

Women may benefit from TAVR despite higher complications; extends prior RCTs via patient-level meta-analysis.

Key Points

  • This study aims to evaluate how sex influences outcomes after transcatheter aortic valve replacement, focusing on mortality and safety.
  • Collaborative meta-analysis using data from 5 studies in MEDLINE, Embase, and Cochrane Library
  • Generated a patient-level database encompassing time-to-event data from selected studies
  • Primary outcome was all-cause mortality, with 30-day safety endpoints including major vascular complications, bleeding, and stroke
  • Women had higher rates of major vascular complications (6.3% vs. 3.4%; p < 0.001) and major bleeding events (10.5% vs. 8.5%; p = 0.003)
  • No differences in procedural 30-day mortality (2.6% vs. 2.2%; p = 0.24)
  • Female sex linked to improved survival at median follow-up of 387 days (adjusted HR 0.79; 95% CI 0.73-0.86; p = 0.001)

Study Design

Type

Meta-Analysis (n=11,310)

Multicenter

Yes

Structured PICO

Does female sex influence mortality and safety outcomes in patients undergoing transcatheter aortic valve replacement?

P
Population
11,310 patients undergoing transcatheter aortic valve replacement, followed for a median of 387 days.
E
Exposure
Female sex
C
Comparator
Male sex
O
Outcome
All-cause mortalityhard clinical

Main Result

Hazard Ratio: 0.79 (95% CI 0.73–0.86)

p-value: p=0.001

Female sex is an independent predictor of late survival after TAVR, despite higher early rates of bleeding, vascular, and stroke complications.

Cite This Study

O’Connor et al. (2015) conducted a meta-analysis in transcatheter aortic valve replacement (n=11,310). Female sex vs. Male sex was evaluated on all-cause mortality (adjusted HR 0.79, 95% CI 0.73 to 0.86, p=0.001). Female sex was independently associated with improved survival after transcatheter aortic valve replacement (adjusted HR 0.79; 95% CI 0.73-0.86; p=0.001), despite more bleeding and vascular events.

synapsesocial.com/papers/6a2ccc1fb3cfc6b60e4443e2https://doi.org/10.1016/j.jacc.2015.05.024
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Also Consider

Synapse has enriched 4 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Sex-Related Differences in Outcomes After Transcatheter or Surgical Aortic Valve Replacement in Patients With Severe Aortic Stenosis2014 · 199 citations
  2. 2Regression of Myocardial Hypertrophy After Aortic Valve Replacement2010 · 231 citations
  3. 3Patient selection for transcatheter aortic valve implantation: An interventional cardiology perspective.2012 · 39 citations
  4. 4Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document (VARC-2)2012 · 3,374 citations